Provider Demographics
NPI:1255768024
Name:DEPARTMENT OF JUVENILE JUSTICE
Entity type:Organization
Organization Name:DEPARTMENT OF JUVENILE JUSTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNPC
Authorized Official - Prefix:
Authorized Official - First Name:ALMA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:770-531-6083
Mailing Address - Street 1:540 CRESENT DR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-5079
Mailing Address - Country:US
Mailing Address - Phone:770-531-6083
Mailing Address - Fax:770-531-4587
Practice Address - Street 1:450 CRESCENT DR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-5079
Practice Address - Country:US
Practice Address - Phone:770-531-6083
Practice Address - Fax:770-531-4587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-10
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN069188313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility