Organization
MAGNOLIA GARDENS PCH, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TERI D. CARGILL (DIRECTOR)
(678) 697-0575
Entity
Organization
Contact information
Practice address
5348 KELLEYS CREEK DR, STONE MOUNTAIN, GA 30088-3827
(770) 469-8925
(770) 469-8925
Mailing address
PO BOX 684, LOVEJOY, GA 30250-0684
(770) 469-8925
(770) 469-8925
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
256949895B
—
GA
Enumeration date
07/31/2009
Last updated
03/12/2010
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