Provider Demographics
NPI:1437375672
Name:CREW STREET COMMUNITY INTEGRATION HOME
Entity Type:Organization
Organization Name:CREW STREET COMMUNITY INTEGRATION HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:
Authorized Official - Last Name:SALANDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-819-0901
Mailing Address - Street 1:885 CREW ST SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30315-1540
Mailing Address - Country:US
Mailing Address - Phone:404-586-9260
Mailing Address - Fax:
Practice Address - Street 1:885 CREW ST SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30315-1540
Practice Address - Country:US
Practice Address - Phone:404-586-9260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044232261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)