Provider Demographics
NPI:1417198458
Name:NACIEMA CORPORATION
Entity Type:Organization
Organization Name:NACIEMA CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SLADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-847-1353
Mailing Address - Street 1:3200 STONE RD SW APT W8
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-2920
Mailing Address - Country:US
Mailing Address - Phone:678-847-1353
Mailing Address - Fax:
Practice Address - Street 1:3200 STONE RD SW APT W8
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-2920
Practice Address - Country:US
Practice Address - Phone:678-847-1353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-22
Last Update Date:2009-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children