Georgia Community Living Facilities LLC

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

License

007874 Issued in GA

Legal business name

GEORGIA COMMUNITY LIVING FACILITIES LLC

Practice address

500 Lanier Ave W Ste 610
Fayetteville, GA 30214-7644

Phone

(404) 829-2715

Fax

(678) 817-5909

NPI assigned

Dec 8, 2011

Organization subpart

No

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

Authorized official

Name

Ms. Rhonda Ann Crockett

Title

Owner/President

Phone

(404) 829-2715

Specialties & licenses 5

Addresses

Locations

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

{
    "created_epoch": "1323302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1364515200000",
    "number": "1730457458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 LANIER AVE W STE 610",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302147644",
            "telephone_number": "404-829-2715",
            "fax_number": "678-817-5909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 LANIER AVE W STE 610",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302147644",
            "telephone_number": "404-829-2715",
            "fax_number": "678-817-5909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGIA COMMUNITY LIVING FACILITIES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-08",
        "last_updated": "2013-03-29",
        "status": "A",
        "authorized_official_last_name": "CROCKETT",
        "authorized_official_first_name": "RHONDA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "404-829-2715",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "GA",
            "license": "007876",
            "primary": false
        },
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "GA",
            "license": "007874",
            "primary": true
        },
        {
            "code": "385HR2060X",
            "taxonomy_group": "",
            "desc": "Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Illness Community Based Residential Treatment Facility in Fayetteville, GA
• Providers in Fayetteville, 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 Mar 29, 2013; 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.