Provider Demographics
NPI:1437676632
Name:IDA'S COVE
Entity Type:Organization
Organization Name:IDA'S COVE
Other - Org Name:LITTLE DEBBIE'S COMMUNITY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LAKISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:STIGGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-912-3742
Mailing Address - Street 1:4280 MEMORIAL DR STE C
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-1216
Mailing Address - Country:US
Mailing Address - Phone:770-912-3742
Mailing Address - Fax:
Practice Address - Street 1:4280 MEMORIAL DR STE C
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-1216
Practice Address - Country:US
Practice Address - Phone:770-912-3742
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-28
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health