Provider Demographics
NPI:1902232598
Name:ENABLE OF GEORGIA, INC.
Entity Type:Organization
Organization Name:ENABLE OF GEORGIA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:STERN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:770-664-4347
Mailing Address - Street 1:1200 OLD ELLIS RD
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-3850
Mailing Address - Country:US
Mailing Address - Phone:770-664-4347
Mailing Address - Fax:770-740-0650
Practice Address - Street 1:1200 OLD ELLIS RD
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-3850
Practice Address - Country:US
Practice Address - Phone:770-664-4347
Practice Address - Fax:770-740-0650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-16
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities