Kelly'S Life Center

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

License

031012958 Issued in GA

Legal business name

KELLY'S LIFE CENTER

Practice address

3895 Tolliver Hills Dr
Ellenwood, GA 30294-1209

Phone

(404) 228-7985

Fax

(404) 963-7812

NPI assigned

Nov 3, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Teressa Douglas

Title

Owner

Phone

(404) 228-7985

Specialties & licenses 2

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1288742400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1288742400000",
    "number": "1144521428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1616 COLUMBIA DR",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300324613",
            "telephone_number": "404-228-7985",
            "fax_number": "404-963-7812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3895 TOLLIVER HILLS DR",
            "city": "ELLENWOOD",
            "state": "GA",
            "postal_code": "302941209",
            "telephone_number": "404-228-7985",
            "fax_number": "404-963-7812"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELLY'S LIFE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-03",
        "last_updated": "2010-11-03",
        "status": "A",
        "authorized_official_last_name": "DOUGLAS",
        "authorized_official_first_name": "TERESSA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "404-228-7985"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "GA",
            "license": "031012958",
            "primary": false
        },
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "GA",
            "license": "031012958",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Journey to Health Nemt
• Jovial Home Healthcare LLC
• Joy in the Morning Therapy and Consulting, LLC
• K'S House
• Keisha Patterson
• Monica Kendrick, PTA
• Ket Cares & Education LLC
• Khrysalis Empowerment Inc.
• Opeyemi Gloria Kilanko
• Kimberly Norris, OT, Inc.

• Mental Illness Community Based Residential Treatment Facility in Ellenwood, GA
• Providers in Ellenwood, GA by specialty
• Mental Illness Community Based Residential Treatment Facility in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.