Exquisite Traditions

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

PCH001261 Issued in GA

Legal business name

EXQUISITE TRADITIONS

Practice address

7265 Mount Zion Blvd
Jonesboro, GA 30236-2519

Phone

(404) 525-9500

Fax

(404) 393-9436

NPI assigned

Jun 20, 2011

Last updated

Jun 20, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kyle Ballif

Title

Ceo

Phone

(404) 525-9500

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1308528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1308528000000",
    "number": "1558657494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2045 MOUNT ZION RD",
            "address_2": "SUITE 397",
            "city": "MORROW",
            "state": "GA",
            "postal_code": "302603313",
            "telephone_number": "404-525-9500",
            "fax_number": "404-393-9436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7265 MOUNT ZION BLVD",
            "city": "JONESBORO",
            "state": "GA",
            "postal_code": "302362519",
            "telephone_number": "404-525-9500",
            "fax_number": "404-393-9436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXQUISITE TRADITIONS",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-20",
        "last_updated": "2011-06-20",
        "status": "A",
        "authorized_official_last_name": "BALLIF",
        "authorized_official_first_name": "KYLE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "404-525-9500"
    },
    "taxonomies": [
        {
            "code": "320700000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Physical Disabilities",
            "state": "GA",
            "license": "PCH001261",
            "primary": false
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "GA",
            "license": "PCH001261",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2011; 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.