Provider Demographics
NPI:1477134385
Name:THE RETREAT OF ATLANTA LLC
Entity Type:Organization
Organization Name:THE RETREAT OF ATLANTA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEANA
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:954-882-1332
Mailing Address - Street 1:100 NW 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-2814
Mailing Address - Country:US
Mailing Address - Phone:954-789-2161
Mailing Address - Fax:954-764-6558
Practice Address - Street 1:155 GREENSBORO RD
Practice Address - Street 2:
Practice Address - City:EATONTON
Practice Address - State:GA
Practice Address - Zip Code:31024-6042
Practice Address - Country:US
Practice Address - Phone:954-789-2161
Practice Address - Fax:954-764-6558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-21
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility