Provider Demographics
NPI:1326392432
Name:EXTENDING COMMUNITY SERVICES FOUNDATION
Entity Type:Organization
Organization Name:EXTENDING COMMUNITY SERVICES FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LATASHA
Authorized Official - Middle Name:D
Authorized Official - Last Name:GUY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-520-7308
Mailing Address - Street 1:3630 EMERALD PT
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-5739
Mailing Address - Country:US
Mailing Address - Phone:678-750-3273
Mailing Address - Fax:
Practice Address - Street 1:3630 EMERALD PT
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-5739
Practice Address - Country:US
Practice Address - Phone:678-750-3273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-29
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities