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St. Mary's Independent Living Extensions
Developmentally Disabled Services Day Training Agency in Lawrenceville, Georgia
NPI 1033506712

St. Mary's Independent Living Extensions is a Developmentally Disabled Services Day Training Agency based in Lawrenceville, GA. St. Mary's Independent Living Extensions practices in Lawrenceville, GA. The NPI Number for St. Mary's Independent Living Extensions is 1033506712 and holds a License No. 067-R-0388 (Georgia).

The current practice location address for St. Mary's Independent Living Extensions is 120 Gloster Rd Nw Ste 3, Lawrenceville, GA and can be reached out via phone at 770-279-5115 and via fax at 770-923-2059.

Location: 120 Gloster Rd Nw Ste 3, Lawrenceville, GA, 30044-4479
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1033506712
Provider Name
St. Mary's Independent Living Extensions
Credential
Provider Entity Type
Organization
Address
120 Gloster Rd Nw Ste 3, Lawrenceville, GA, 30044-4479
Phone Number
770-279-5115
Fax Number
770-923-2059
Provider Enumeration Date
04/21/2015
Last Update Date
03/09/2024
tick
Provider's Legacy Identifiers
Identifier Type State Issuer
779876528B 05 GA
779876528A 05 GA
institution
Provider Business Practice Location Address Details
Address
120 Gloster Rd Nw Ste 3
City
Lawrenceville
State
Georgia
Zip
30044-4479
Phone Number
770-279-5115
Fax Number
770-923-2059
person
Provider Business Mailing Address Details
Address
120 Gloster Rd Nw Ste 3
City
Lawrenceville
State
Georgia
Zip
30044-4479
Phone Number
770-279-5115
Fax Number
770-923-2059
person
Provider's Taxonomy Details 1
Type
Agencies
Classification
Day Training, Developmentally Disabled Services
Speciality
-
Taxonomy
251C00000X
License No.
067-R-0388 (Georgia)
Definition
These agencies are authorized to provide day habilitation services to developmentally disabled individuals who live in their homes. The function of day habilitation is to assist an individual to acquire and maintain those life skills that enable the individual to cope more effectively with the demands of independent living. Also to raise the level of the individual's physical, mental, social, and vocational functioning.
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