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NPI 1407159585 · Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Jonesboro, GA
Provider details
- NPI number
- 1407159585
- Entity type
- Organization
- Primary specialty
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityResidential Treatment Facilities
- Organization subpart
- No
- Authorized official
- Emmanuel Oso, Owner(678) 216-1618
- License
- 031-01-246-1 (GA)
Specialties & taxonomies
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityPrimary320900000XLicense 031-01-246-1 (GA)
Residential Treatment Facilities
Practice location
891 Stormy Ln
Jonesboro, GA 30238-5984
Phone: (678) 216-1618
Approximate (ZIP-level) locationGet directions
Mailing address
891 Stormy Ln
Jonesboro, GA 30238-5984
Registry dates
- Enumerated
- 2010-12-13
- Last updated
- 2010-12-13
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.