Organization · NPI-2
Panola Care, Cla
Residential Treatment Facility, Intellectual and/or Developmental Disabilities · Lithonia, GA
NPI number1134564131
StatusActive
Last updated in NPPESMay 3, 2013
Details
- NPI
- 1134564131
- Entity type
- Organization (NPI-2)
- Legal business name
- Panola Care, Cla
- Organization subpart
- No
- Enumeration date
- May 3, 2013
- Last updated
- May 3, 2013
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 320600000X | Residential Treatment Facility, Intellectual and/or Developmental Disabilities | – | – | Yes |
| 320700000X | Residential Treatment Facility, Physical Disabilities | – | – |
Practice location
3169 Pequea DrLithonia, GA 30038-1119
Phone 770-322-6810 · Fax 770-322-6810
Mailing address
3169 Pequea DrLithonia, GA 30038-1119
Phone 770-322-6810
Authorized official
Carol A Tavares
Director
7703226810
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