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GEORGIA DEPARTMENT OF HUMAN RESOURCES

Intermediate Care Facility, Mentally Retarded

Gracewood, Georgia

Provider NPI: 1699837864

Organization Information:
Organization Name:  GEORGIA DEPARTMENT OF HUMAN RESOURCES


Practice Location:
100 MYRTLE BLVD  GRACEWOOD, GA 30812 US
Tel: 706-790-2030  Fax: --

Business Mailing Address:
  ,   
Tel: --  Fax: --


Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y315P00000XNursing & Custodial Care Facilities
Intermediate Care Facility, Mentally Retarded
GA21211622

Other Provider Identifiers:

IssuerNumberStateType
00869206AGA05
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin




MENTALLY RETARDED JOBS GA - Page 1



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