Provider Demographics
NPI:1851840797
Name:THE ELIM COMMUNITY DEVELOPMENT CENTER
Entity Type:Organization
Organization Name:THE ELIM COMMUNITY DEVELOPMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:OSBORNE
Authorized Official - Middle Name:J
Authorized Official - Last Name:GILES
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:470-658-9284
Mailing Address - Street 1:2714 WATERFORD CLUB DR
Mailing Address - Street 2:
Mailing Address - City:LITHIA SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30122-4413
Mailing Address - Country:US
Mailing Address - Phone:470-658-9284
Mailing Address - Fax:
Practice Address - Street 1:4717 COVINGTON HWY
Practice Address - Street 2:SUITE 109
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30035-2015
Practice Address - Country:US
Practice Address - Phone:470-658-9284
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-03
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health