| Little Debbie's Second Chance Home, Inc. | |
|
3900 Leprechaun Ct Decatur GA 30034-2168 | |
| (770) 912-3742 | |
| (404) 288-0671 |
| Full Name | Little Debbie's Second Chance Home, Inc. |
|---|---|
| Speciality | Residential Treatment Facility, Emotionally Disturbed Children |
| Location | 3900 Leprechaun Ct, Decatur, Georgia |
| Authorized Official Name and Position | Lakisha Shavon Stiggers (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 7709123742 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Little Debbie's Second Chance Home, Inc. 3900 Leprechaun Ct Decatur GA 30034-2168 Ph: (770) 912-3742 | Little Debbie's Second Chance Home, Inc. 3900 Leprechaun Ct Decatur GA 30034-2168 Ph: (770) 912-3742 |
| NPI Number | 1487792396 |
|---|---|
| Provider Enumeration Date | 02/02/2007 |
| Last Update Date | 04/20/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487792396 | NPI | - | NPPES |
| 585299164A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (Georgia) | Secondary |
| 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | CC1001625 (Georgia) | Primary |
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