Organization
INTERGENERATIONAL RESOURCE CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BRENDA EVELYN SANFORD R.N. (EXECUTIVE DIRECTOR)
(404) 524-1023
Entity
Organization
Contact information
Practice address
444 EDGEWOOD AVE SE, ATLANTA, GA 30312-1838
(404) 524-1023
(404) 577-1025
Mailing address
444 EDGEWOOD AVENUE, S.E., ATLANTA, GA 30312-1838
(404) 524-1023
(404) 577-1025
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000120117A
—
GA
05
—
000438105A
—
GA
05
—
000438105B
—
GA
05
—
000438105C
—
GA
05
—
000438105D
—
GA
Enumeration date
05/09/2007
Last updated
09/16/2008
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