Southern International Living, Inc

Primary specialty

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

License

CLA001010 Issued in GA

Legal business name

SOUTHERN INTERNATIONAL LIVING, INC

Practice address

3437 Mount Olive Rd
East Point, GA 30344-5812

Phone

(404) 547-1291

Fax

(404) 551-3549

NPI assigned

Jul 9, 2009

Last updated

May 12, 2012By 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

Mrs. Minnie Lee Ward, CNA

Title

Director

Phone

(404) 684-6884

Specialties & licenses 2

Addresses

Other identifiers 1

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

{
    "created_epoch": "1247097600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1336780800000",
    "number": "1629207733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3437 MOUNT OLIVE RD",
            "city": "EAST POINT",
            "state": "GA",
            "postal_code": "303445812",
            "telephone_number": "404-684-6884",
            "fax_number": "404-551-3549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3437 MOUNT OLIVE RD",
            "city": "EAST POINT",
            "state": "GA",
            "postal_code": "303445812",
            "telephone_number": "404-547-1291",
            "fax_number": "404-551-3549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN INTERNATIONAL LIVING, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-09",
        "last_updated": "2012-05-12",
        "status": "A",
        "authorized_official_last_name": "WARD",
        "authorized_official_first_name": "MINNIE",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "404-684-6884",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CNA"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "GA",
            "license": "CLA000974",
            "primary": false
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "GA",
            "license": "CLA001010",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "181308327A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in East Point, GA
• Providers in East Point, 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 May 12, 2012; 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.