Provider Demographics
NPI:1770160533
Name:RESILIENT RECOVERY SERVICES CORP.
Entity type:Organization
Organization Name:RESILIENT RECOVERY SERVICES CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMILLAH
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:678-993-9852
Mailing Address - Street 1:1277 DAHLGREN LN SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30316-1619
Mailing Address - Country:US
Mailing Address - Phone:678-993-9852
Mailing Address - Fax:
Practice Address - Street 1:1277 DAHLGREN LN SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30316-1619
Practice Address - Country:US
Practice Address - Phone:678-993-9852
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-26
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone