Organization
MANIFEST RECOVERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VICTOR ALFONSO (CEO)
(818) 212-4659
Entity
Organization
Contact information
Practice address
1215 HIGHTOWER TRL STE 201, SANDY SPRINGS, GA 30350-6244
(877) 752-5262
Mailing address
1301 SHILOH RD NW STE 1840, KENNESAW, GA 30144-7171
(877) 752-5262
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
04/26/2018
Last updated
04/26/2018
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