Provider Demographics
NPI:1689926750
Name:FRAGMENTS MINISTRY, INC
Entity Type:Organization
Organization Name:FRAGMENTS MINISTRY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:LEON
Authorized Official - Last Name:CLOUD
Authorized Official - Suffix:
Authorized Official - Credentials:MINISTER
Authorized Official - Phone:678-598-0651
Mailing Address - Street 1:5793 JAMES RD
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30168-4505
Mailing Address - Country:US
Mailing Address - Phone:678-598-0651
Mailing Address - Fax:404-755-3237
Practice Address - Street 1:635 PEARCE ST SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30310-2829
Practice Address - Country:US
Practice Address - Phone:404-755-3237
Practice Address - Fax:404-755-3237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-12
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA082412OtherGEORGIA ASSOCIATION OF RECOVERY RESIDENTS MEMBER STANDARDS
GA102612OtherCERTIFIED BY THE STATE OF GA TO OPERATE AS A SUPPORTIVE HOUSING FACILITY