Provider Demographics
NPI:1891181335
Name:FIRST LADY RESIDENTIAL SERVICE LLC
Entity Type:Organization
Organization Name:FIRST LADY RESIDENTIAL SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-508-3363
Mailing Address - Street 1:401 BARNHILL DR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-5912
Mailing Address - Country:US
Mailing Address - Phone:912-508-3363
Mailing Address - Fax:912-925-5515
Practice Address - Street 1:401 BARNHILL DR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-5912
Practice Address - Country:US
Practice Address - Phone:912-508-3363
Practice Address - Fax:912-925-5515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-10
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities