NPIMap

Organization Active NPI

Ultimate Living Service, Inc

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Stone Mountain, GA
National Provider Identifier
1851626733
Registry record updated Oct 9, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X
License
044017288 Issued in GA
Legal business name
ULTIMATE LIVING SERVICE, INC
Practice address
1516 Crooked Tree Cir
Stone Mountain, GA 30088-3723
Phone
(404) 401-1094
NPI assigned
Oct 9, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2009

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

Authorized official

Name
Dr. Gerald David Tillman, ED.D
Title
Director
Phone
(404) 401-1094

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X 044017288 GA Primary

Addresses

Primary practice location

1516 Crooked Tree Cir
Stone Mountain, GA 30088-3723

Mailing address

1516 Crooked Tree Cir
Stone Mountain, GA 30088-3723
Phone (404) 401-1094

National Provider Directory

National Provider Directory
Tax ID family
Ultimate Living Service Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1255046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1255046400000",
    "number": "1851626733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1516 CROOKED TREE CIR",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300883723",
            "telephone_number": "404-401-1094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1516 CROOKED TREE CIR",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300883723",
            "telephone_number": "404-401-1094"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ULTIMATE LIVING SERVICE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-09",
        "last_updated": "2009-10-09",
        "status": "A",
        "authorized_official_last_name": "TILLMAN",
        "authorized_official_first_name": "GERALD",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "404-401-1094",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "ED.D"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "GA",
            "license": "044017288",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stone Mountain, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2009; 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.