St. Mary'S Independent Living Extensions

LBN: St. Mary'S Independent Living Extensions
St. Mary'S Independent Living Extensions is an health care organization with primary practice located at 120 Gloster Rd Nw Ste 3 , Lawrenceville GA 30044-4479. The organization recently has only one registered license in Agencies / Day Training, Developmentally Disabled Services, which is considered as the primary health care specialty. St. Mary'S Independent Living Extensions can be contacted via phone (770) 279-5115, or through Pieper, Paul via phone (770) 279-5115.

Contact Information

Primary practice address
120 Gloster Rd Nw Ste 3 Lawrenceville GA 30044-4479
Phone: (770) 279-5115
Fax: (770) 923-2059
Website:
Map and Directions
Authorized official contact:
Name: Pieper, Paul
Phone: (770) 279-5115

Health care specialties

SpecialtyCodeLicense #State
Agencies / Day Training, Developmentally Disabled Services 251C00000X 067-R-0388 Georgia

Profile Details

NPI number 1033506712
LBN Legal business name St. Mary'S Independent Living Extensions
DBA Doing business as
Authorized official Pieper, Paul
Entity Organization
Organization subpart 1 No
Enumeration date Apr 21st, 2015
Last updated Apr 21st, 2015 - about 11 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1033506712 NPPES
Georgia MEDICAID 779876528B
Georgia MEDICAID 779876528A

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