Provider Demographics
NPI:1891850582
Name:GLEATON HOME PROVIDERS
Entity Type:Organization
Organization Name:GLEATON HOME PROVIDERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NIKKI
Authorized Official - Middle Name:
Authorized Official - Last Name:GLEATON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-625-8897
Mailing Address - Street 1:80 WISTERIA DR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30054-4018
Mailing Address - Country:US
Mailing Address - Phone:678-625-8897
Mailing Address - Fax:678-625-0619
Practice Address - Street 1:80 WISTERIA DR
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:GA
Practice Address - Zip Code:30054-4018
Practice Address - Country:US
Practice Address - Phone:678-625-8897
Practice Address - Fax:678-625-0619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities