PREDESTINED FOR GREATNESS (NPI# 1154537181) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154537181 |
| Entity Type | Organization |
| Organization Name | PREDESTINED FOR GREATNESS |
| Practice Address |
4865 Brookstone Pkwy Ellenwood GA 30294-2126 |
| Practice Telephone | 7703209278 |
| Mailing Telephone | 7703209278 |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MR. DION THOMAS (CEO) |
| Authorized Official Telephone | 7703209278 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | CCI001578 | GA | Residential Treatment Facilities |
| Street Address |
4865 BROOKSTONE PKWY |
| City | ELLENWOOD |
| State | GA |
| Zip Code | 30294-2126 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770124323 | Lula Varist Gholson | Counselor | Christian Counselor Ma Lou Gholson, 549 Lamar Drive, Forest Park, GA 30294 | 2019-10-04 |
| 1609428176 | Tykechia Todd | Ambulance | 3644 Caseys Cove, Ellenwood, GA 30294 | 2019-07-15 |
| 1891285243 | Ayana Aqila Thornton | Nurse Practitioner | 5654 Hosea Court, Ellenwood, GA 30294 | 2018-05-11 |
| 1346748837 | Kakethia S. Mack | Nurse Practitioner | 4124 Bosenberry Way, Ellenwood, GA 30294 | 2018-01-30 |
| 1851819312 | Tatiana Marcus | Prosthetist | 3895 Busby Mill Ct., Ellenwood, GA 30294 | 2017-09-05 |
| 1962944991 | Fairview Urgent Care, LLC | Clinic/Center | 4475 West Village Pkwy, Ellenwood, GA 30294 | 2016-11-08 |
| 1982006169 | Kristal Cure | Licensed Practical Nurse | 4057 Madiosn Court, Ellenwood, GA 30294 | 2014-09-19 |
| 1801233515 | 1st Class Learning and Performing Arts | Local Education Agency (LEA) | 5474 Platte Dr, Ellenwood, GA 30294 | 2013-06-04 |
| 1235480138 | Life Wellness Group of Atlanta | Home Delivered Meals | 145 Wilhemina Drive, Ellenwood, GA 30294 | 2012-10-02 |
| 1346548450 | William K Holley IIi | Counselor | 2732 Holly Berry Dr, Ellenwood, GA 30294 | 2011-03-14 |
| Find all providers in zip 30294 | ||||
| Taxonomy Code | 322D00000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Emotionally Disturbed Children |
| A provider facility or distinct part of the organization which renders an interdisciplinary program of mental health treatment to individuals under 21 years of age who have persistent dysfunction in major life areas. The dysfunction is of an extent and pervasiveness that requires a protected and highly structured therapeutic environment. These organizations, or distinct part of organizations, exclude those that provide acute psychiatric care, partial hospitalization, group living, therapeutic schooling, primary diagnosis substance abuse disorder treatment, or primary diagnosis mental retardation or developmental disability treatment. |
| Notes: Source: U.S. Department of Defense Regulation 6010.8-R, Chapter 6. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023543766 | One Heart and One Mind Inc | Residential Treatment Facility, Emotionally Disturbed Children | 5737 Old National Hwy, Suite 300, Atlanta, GA 30349-7410 | 2017-05-01 |
| 1396131249 | There's No Place Like A Loving Home LLC | Residential Treatment Facility, Emotionally Disturbed Children | 2000 Jardin Ct, Alpharetta, GA 30022-4600 | 2015-04-07 |
| 1912343302 | Our Spot | Residential Treatment Facility, Emotionally Disturbed Children | 1015 E Inman St, Statesboro, GA 30458-2049 | 2013-05-13 |
| 1902163520 | Shepherd's Hill Academy, Inc | Residential Treatment Facility, Emotionally Disturbed Children | 2200 Price Rd, Martin, GA 30557-3457 | 2012-04-20 |
| 1871879312 | Vision Youth Services Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 4228 Redan Rd, Stone Mountain, GA 30083-5040 | 2011-10-28 |
| 1356634034 | Soaring Eagle Children's Group | Residential Treatment Facility, Emotionally Disturbed Children | 3183 Northbrook Dr, Atlanta, GA 30341-4629 | 2011-05-27 |
| 1124330386 | Favorable Network Solutions | Residential Treatment Facility, Emotionally Disturbed Children | 881 Memorial Dr Se, Suite 213, Atlanta, GA 30316-1270 | 2010-07-04 |
| 1467687665 | Positive Impact Hhs, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 934 Garden Walk Blvd. # 903, College Park, GA 30349-8508 | 2009-05-18 |
| 1932342235 | The Sanctuary House, Inc | Residential Treatment Facility, Emotionally Disturbed Children | 500 John Deere Rd Nw, Monroe, GA 30656-4769 | 2009-04-16 |
| 1417198458 | Naciema Corporation | Residential Treatment Facility, Emotionally Disturbed Children | 3200 Stone Rd Sw Apt W8, Atlanta, GA 30331-2920 | 2009-03-22 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.