Provider Demographics
NPI:1720382039
Name:ROSALENA'S COMMUNITY DEVELOPMENT CENTER INC
Entity Type:Organization
Organization Name:ROSALENA'S COMMUNITY DEVELOPMENT CENTER INC
Other - Org Name:ROSALEANA'S COMMUNITY ASSISTEDLIVING CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:YALANA
Authorized Official - Middle Name:YELAINE
Authorized Official - Last Name:BARBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-392-4496
Mailing Address - Street 1:350 SCHOEN ST SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30315-5308
Mailing Address - Country:US
Mailing Address - Phone:404-392-4496
Mailing Address - Fax:
Practice Address - Street 1:350 SCHOEN ST SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30315-5308
Practice Address - Country:US
Practice Address - Phone:404-392-4496
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-29
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060013711320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities