Provider Demographics
NPI:1184059107
Name:WE THE FAMILY WELLNESS HOME
Entity type:Organization
Organization Name:WE THE FAMILY WELLNESS HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MALISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKENNIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-485-6099
Mailing Address - Street 1:1322 COLUMBIA DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-2826
Mailing Address - Country:US
Mailing Address - Phone:678-485-6088
Mailing Address - Fax:
Practice Address - Street 1:1322 COLUMBIA DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-2826
Practice Address - Country:US
Practice Address - Phone:678-485-6088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness