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Shirley Home Away From Home
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Fayetteville, Georgia
NPI 1457684482

Shirley Home Away From Home is a Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility based in Fayetteville, GA. Shirley Home Away From Home practices in Fayetteville, GA. The NPI Number for Shirley Home Away From Home is 1457684482 and holds a License No. 056-01-011-1 (Georgia).

The current practice location address for Shirley Home Away From Home is 190 Middling Ln, Fayetteville, GA and can be reached out via phone at 678-557-2207.

Location: 190 Middling Ln, Fayetteville, GA, 30214-3767
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1457684482
Provider Name
Shirley Home Away From Home
Credential
Provider Entity Type
Organization
Address
190 Middling Ln, Fayetteville, GA, 30214-3767
Phone Number
678-557-2207
Fax Number
Provider Enumeration Date
09/09/2009
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
155482054B 05 GA
institution
Provider Business Practice Location Address Details
Address
190 Middling Ln
City
Fayetteville
State
Georgia
Zip
30214-3767
Phone Number
678-557-2207
Fax Number
person
Provider Business Mailing Address Details
Address
190 Middling Ln
City
Fayetteville
State
Georgia
Zip
30214-3767
Phone Number
678-557-2207
Fax Number
person
Provider's Taxonomy Details 1
Type
Residential Treatment Facilities
Classification
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Speciality
-
Taxonomy
320900000X
License No.
056-01-011-1 (Georgia)
Definition
A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with intellectual and/or developmental disabilities.
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