Provider Demographics
NPI:1275713174
Name:MY SISTER'S KEEPER FAMILY SERVICES, INC.
Entity Type:Organization
Organization Name:MY SISTER'S KEEPER FAMILY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXE. DIRECTO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:D
Authorized Official - Last Name:STROMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:770-994-0607
Mailing Address - Street 1:7431 PETUNIA DR
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30296-1185
Mailing Address - Country:US
Mailing Address - Phone:770-994-0607
Mailing Address - Fax:770-994-6621
Practice Address - Street 1:804 COMMERCE BLVD STE A8
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30296-3321
Practice Address - Country:US
Practice Address - Phone:678-760-6599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA145255627A251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA145255627AMedicaid