Panola Care, Cla

NPI #1134564131 in Lithonia, Georgia

Provider Information

NPI Number: 1134564131
Entity Type: Organization
Organization Name: Panola Care, Cla
Primary Specialty: Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Enumeration Date: May 3, 2013
Last Updated: May 3, 2013

Practice Location

Address: 3169 PEQUEA DR
City: Lithonia
State: Georgia
ZIP Code: 30038-1119
Phone: (770) 322-6810

Authorized Official

Name: MISS CAROL A TAVARES
Title: DIRECTOR
Phone: (770) 322-6810

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Residential Treatment Facility, Physical Disabilities	320700000X
Residential Treatment Facility, Intellectual and/or Developmental Disabilities	320600000X	Primary

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