Provider Demographics
NPI:1316209083
Name:ELKS AIDMORE, INC.
Entity Type:Organization
Organization Name:ELKS AIDMORE, INC.
Other - Org Name:ELKS AIDMORE CHILDREN'S CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ABE
Authorized Official - Middle Name:MEYER
Authorized Official - Last Name:WILKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-483-3535
Mailing Address - Street 1:2394 MORRISON RD SW
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-3330
Mailing Address - Country:US
Mailing Address - Phone:770-483-3535
Mailing Address - Fax:770-483-5696
Practice Address - Street 1:2394 MORRISON RD SW
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-3330
Practice Address - Country:US
Practice Address - Phone:770-483-3535
Practice Address - Fax:770-483-5696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-08
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAC1000Q010056253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency