Provider Demographics
NPI:1275663148
Name:COMPREHENSIVE FAMILY CARE LLC
Entity Type:Organization
Organization Name:COMPREHENSIVE FAMILY CARE LLC
Other - Org Name:HASSAN B. KING MEMORIAL GROUP HOME INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MONIQUE
Authorized Official - Middle Name:DIONNE
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:404-399-1366
Mailing Address - Street 1:1429 SMITHSON DR
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-6155
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1429 SMITHSON DR
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-6155
Practice Address - Country:US
Practice Address - Phone:404-399-1366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171W00000X
GACI0000012125322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered171W00000XOther Service ProvidersContractorGroup - Single Specialty
Not Answered322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children