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NPI 1790925915 · Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Fayetteville, GA
Provider details
- NPI number
- 1790925915
- Entity type
- Organization
- Primary specialty
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityResidential Treatment Facilities
- Organization subpart
- No
- Authorized official
- Sheila Taylor, Ceo(678) 469-3977
Specialties & taxonomies
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityPrimary320900000X
Residential Treatment Facilities
Practice location
285 Vickery Ln
Fayetteville, GA 30215-4680
Phone: (678) 469-3977
Fax: (770) 755-1397
Approximate (ZIP-level) locationGet directions
Mailing address
285 Vickery Ln
Fayetteville, GA 30215-4680
Registry dates
- Enumerated
- 2009-02-27
- Last updated
- 2009-02-27
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.