Hattie Clay Oliver Pch

NPI #1104194307 in Mableton, Georgia

Provider Information

NPI Number: 1104194307
Entity Type: Organization
Organization Name: Hattie Clay Oliver Pch
Primary Specialty: Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Enumeration Date: Dec 2, 2011
Last Updated: Dec 6, 2011

Practice Location

Address: 418 VININGS VINTAGE CIR
City: Mableton
State: Georgia
ZIP Code: 30126-7208
Phone: (770) 575-0582

Authorized Official

Name: MR. JAMES C FORD
Title: CEO
Phone: (770) 575-0582

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities	320900000X
Residential Treatment Facility, Intellectual and/or Developmental Disabilities	320600000X	Primary

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