Provider Demographics
NPI:1780320374
Name:CLAIBORNES COMMUNITY SERVICE, LLC
Entity type:Organization
Organization Name:CLAIBORNES COMMUNITY SERVICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:CLAIBORNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-438-5918
Mailing Address - Street 1:1401 WYNNES RIDGE CIR SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-6043
Mailing Address - Country:US
Mailing Address - Phone:404-438-5918
Mailing Address - Fax:
Practice Address - Street 1:1401 WYNNES RIDGE CIR SE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-6043
Practice Address - Country:US
Practice Address - Phone:404-438-5918
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-07
Last Update Date:2022-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services