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Organization

BREAD OF LIFE ASSISTED LIVING CORPORATION

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. CHRISTINE NWANKWO (EXECUTIVE DIRECTOR)
(678) 732-8191
Entity
Organization

Contact information

Practice address
2001 MARTIN LUTHER KING JR DR SW, SUITE 450-A, ATLANTA, GA 30310-1101
(678) 732-8191
(404) 564-6487
Mailing address
2001 MARTIN LUTHER KING JR DR SW, SUITE 450-A, ATLANTA, GA 30310-1101
(678) 732-8191
(404) 564-6487

Taxonomy

Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
GA
251J00000X
Nursing Care Agency
GA
3104A0625X
Assisted Living Facility (Mental Illness)
Primary
GA
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
GA

Other

Enumeration date
08/21/2012
Last updated
08/21/2012
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