Provider Demographics
NPI:1760250914
Name:ST DOMINIC SAVIO MOTIVATIONAL PLACE (DSMP), INC.
Entity Type:Organization
Organization Name:ST DOMINIC SAVIO MOTIVATIONAL PLACE (DSMP), INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:WALCOT
Authorized Official - Last Name:CEESAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-642-1723
Mailing Address - Street 1:5734 WINCHESTER PL # 5734
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-4082
Mailing Address - Country:US
Mailing Address - Phone:404-859-3216
Mailing Address - Fax:
Practice Address - Street 1:4077 FLAT SHOALS PKWY
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-4104
Practice Address - Country:US
Practice Address - Phone:404-859-3216
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities