Provider Demographics
NPI:1932342235
Name:THE SANCTUARY HOUSE, INC
Entity Type:Organization
Organization Name:THE SANCTUARY HOUSE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LEKEISHA
Authorized Official - Middle Name:PATRICE
Authorized Official - Last Name:BANKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-492-0187
Mailing Address - Street 1:5631 TUNBRIDGE WELLS RD
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-5681
Mailing Address - Country:US
Mailing Address - Phone:678-492-0187
Mailing Address - Fax:440-794-5974
Practice Address - Street 1:500 JOHN DEERE RD NW
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30656-4769
Practice Address - Country:US
Practice Address - Phone:678-492-0187
Practice Address - Fax:440-794-5974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-16
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children