Provider Demographics
NPI:1235491283
Name:METRO COMMUNITY SERVICES
Entity Type:Organization
Organization Name:METRO COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUSTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:OBODE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-339-2600
Mailing Address - Street 1:134 S CLAYTON ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-5743
Mailing Address - Country:US
Mailing Address - Phone:770-339-2600
Mailing Address - Fax:
Practice Address - Street 1:134 S CLAYTON ST
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-5743
Practice Address - Country:US
Practice Address - Phone:770-339-2600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-14
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA385HR2060X385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child