Provider Demographics
NPI:1518004217
Name:CHRIST THE KING DAY HABILITATION SERVICES, INC.
Entity Type:Organization
Organization Name:CHRIST THE KING DAY HABILITATION SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:AUGUSTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-767-4171
Mailing Address - Street 1:5155 SCOFIELD RD
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30349-3301
Mailing Address - Country:US
Mailing Address - Phone:404-767-4171
Mailing Address - Fax:404-559-8804
Practice Address - Street 1:5155 SCOFIELD RD
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30349-3301
Practice Address - Country:US
Practice Address - Phone:404-767-4171
Practice Address - Fax:404-559-8804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QA0600X
GA20065203373H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation SpecialistGroup - Single Specialty
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA134087992AMedicaid
GA134087992BMedicaid