Provider Demographics
NPI:1366752578
Name:IJN CHILD & ADULT CARE HOMES
Entity type:Organization
Organization Name:IJN CHILD & ADULT CARE HOMES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-447-0800
Mailing Address - Street 1:P.O. BOX 370213
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30037-0213
Mailing Address - Country:US
Mailing Address - Phone:404-447-0800
Mailing Address - Fax:404-284-7478
Practice Address - Street 1:1949 VICKI LANE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30316-4108
Practice Address - Country:US
Practice Address - Phone:404-447-0800
Practice Address - Fax:404-284-7478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-21
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA416579002A320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities