Provider Demographics
NPI:1417029729
Name:KIDSPEACE NATIONAL CENTERS OF GEORGIA INC
Entity Type:Organization
Organization Name:KIDSPEACE NATIONAL CENTERS OF GEORGIA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP FOR MARKETING AND BUSINESS DEVEL
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:SLACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-854-3123
Mailing Address - Street 1:4085 INDEPENDENCE DRIVE
Mailing Address - Street 2:
Mailing Address - City:SCHNECKSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18078
Mailing Address - Country:US
Mailing Address - Phone:800-854-3123
Mailing Address - Fax:610-799-8318
Practice Address - Street 1:101 KIDSPEACE DRIVE
Practice Address - Street 2:
Practice Address - City:BOWDEN
Practice Address - State:GA
Practice Address - Zip Code:30108
Practice Address - Country:US
Practice Address - Phone:770-437-7200
Practice Address - Fax:770-258-9128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACC1001402323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility