Provider Demographics
NPI:1720322563
Name:LOVING TOUCH CHRISTIAN ACADEMY, INC.
Entity Type:Organization
Organization Name:LOVING TOUCH CHRISTIAN ACADEMY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:ELNORA
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:MASTERS
Authorized Official - Phone:404-557-4650
Mailing Address - Street 1:7130 MOUNT ZION BLVD
Mailing Address - Street 2:SUITE 11
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-2566
Mailing Address - Country:US
Mailing Address - Phone:404-557-4650
Mailing Address - Fax:
Practice Address - Street 1:7130 MOUNT ZION BLVD
Practice Address - Street 2:SUITE 11
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-2566
Practice Address - Country:US
Practice Address - Phone:404-557-4650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-17
Last Update Date:2012-11-17
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
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA084116372BMedicaid
GA084116372EMedicaid
GA084116372AMedicaid