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Marthalene Logan
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Bethlehem, Georgia
NPI 1700289048

Marthalene Logan is a Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility based in Athens, GA. Marthalene Logan practices in Bethlehem, GA. The NPI Number for Marthalene Logan is 1700289048 and holds a License No. (Georgia).

The current practice location address for Marthalene Logan is 4514 Yorktown Dr, Bethlehem, GA and can be reached out via phone at 678-635-5463.

Location: 4514 Yorktown Dr, Bethlehem, GA, 30601-2244
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1700289048
Provider Name
Marthalene Logan
Credential
Provider Entity Type
Individual
Gender
Female
Address
4514 Yorktown Dr, Bethlehem, GA, 30601-2244
Phone Number
678-635-5463
Fax Number
Provider Enumeration Date
10/01/2014
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
4514 Yorktown Dr
City
Bethlehem
State
Georgia
Zip
30620-4826
Phone Number
678-635-5463
Fax Number
person
Provider Business Mailing Address Details
Address
4514 Yorktown Dr
City
Bethlehem
State
Georgia
Zip
30620-4826
Phone Number
678-635-5463
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.
()
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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