Organization
SECOND NATURE BLUE RIDGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGIE EVANS (BUSINESS OFFICE)
(801) 766-6604
Entity
Organization
Contact information
Practice address
236 FILE STREET, CLAYTON, GA 30525-3023
(706) 212-2037
(706) 212-0354
Mailing address
236 FILE STREET, CLAYTON, GA 30525-3023
(706) 212-2037
(706) 212-0354
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
50017
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
50017
STATE LICENSE NUMBER
GA
Enumeration date
05/08/2007
Last updated
05/29/2012
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