Provider Demographics
NPI:1316221815
Name:AIDEN'S PLACE, LLC
Entity Type:Organization
Organization Name:AIDEN'S PLACE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RONDINE
Authorized Official - Middle Name:D
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-573-1076
Mailing Address - Street 1:1227 ROCKBRIDGE RD
Mailing Address - Street 2:SUITE 208-196
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-3064
Mailing Address - Country:US
Mailing Address - Phone:770-573-1076
Mailing Address - Fax:770-234-5894
Practice Address - Street 1:7370 WRIGHT DR
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30349-7911
Practice Address - Country:US
Practice Address - Phone:770-573-1076
Practice Address - Fax:770-234-5894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-03
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPCH008079320800000X, 320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness