My Fathers Estate, LLC

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

License

075010578 Issued in GA

Legal business name

MY FATHERS ESTATE, LLC

Practice address

1928 Flat Rock Rd
Stockbridge, GA 30281-2039

Phone

(770) 356-2479

Fax

(770) 474-3904

NPI assigned

Nov 8, 2010

Organization subpart

No

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

Authorized official

Name

Ms. Shirley Brown

Title

Ceo

Phone

(770) 356-2479

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1289174400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1289174400000",
    "number": "1265733299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1928 FLAT ROCK RD",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302812039",
            "telephone_number": "770-356-2479",
            "fax_number": "770-474-3904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1928 FLAT ROCK RD",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302812039",
            "telephone_number": "770-356-2479",
            "fax_number": "770-474-3904"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MY FATHERS ESTATE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-08",
        "last_updated": "2010-11-08",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "SHIRLEY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "770-356-2479",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "GA",
            "license": "075010578",
            "primary": true
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "GA",
            "license": "075010578",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Stockbridge, GA
• Providers in Stockbridge, GA by specialty
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 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.