St. Mary's Independent Living Extensions
NPI #1033506712 in Lawrenceville, Georgia
Provider Information
- NPI Number
- 1033506712
- Entity Type
- Organization
- Organization Name
- St. Mary's Independent Living Extensions
- Primary Specialty
- Day Training, Developmentally Disabled Services
- Enumeration Date
- Apr 21, 2015
- Last Updated
- Apr 21, 2015
Practice Location
- Address
- 120 GLOSTER RD NW STE 3
- City
- Lawrenceville
- State
- Georgia
- ZIP Code
- 30044-4479
- Phone
- (770) 279-5115
Authorized Official
- Name
- PAUL PIEPER
- Title
- EXECUTIVE DIRECTOR
- Phone
- (770) 279-5115
Specialties & Taxonomy Codes
| Specialty |
|---|
| Day Training, Developmentally Disabled Services |
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