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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