Provider Demographics
NPI:1255640983
Name:OUR PARENTS PLACE
Entity type:Organization
Organization Name:OUR PARENTS PLACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:BELOVED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-917-6643
Mailing Address - Street 1:7081 SOUTHLAKE PARKWAY
Mailing Address - Street 2:
Mailing Address - City:MORROW
Mailing Address - State:GA
Mailing Address - Zip Code:30260
Mailing Address - Country:US
Mailing Address - Phone:404-917-6643
Mailing Address - Fax:
Practice Address - Street 1:7081 SOUTHLAKE PARKWAY
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260
Practice Address - Country:US
Practice Address - Phone:404-917-6643
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA00000000011385HR2065X
385HR2050X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2050XRespite Care FacilityRespite CareRespite Care Camp
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000000000000Medicaid
GA000000000012Medicaid