Provider Demographics
NPI:1356634034
Name:SOARING EAGLE CHILDREN'S GROUP
Entity Type:Organization
Organization Name:SOARING EAGLE CHILDREN'S GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARION
Authorized Official - Middle Name:OTIS
Authorized Official - Last Name:FARMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-314-3201
Mailing Address - Street 1:3183 NORTHBROOK DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-4629
Mailing Address - Country:US
Mailing Address - Phone:770-314-3201
Mailing Address - Fax:770-818-5512
Practice Address - Street 1:3183 NORTHBROOK DR
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-4629
Practice Address - Country:US
Practice Address - Phone:770-314-3201
Practice Address - Fax:770-818-5512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-27
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children