POSITIVE IMPACT RESIDENTIAL SERVICES
Ambulatory Health at Ponce De Leon Ave, Decatur, GA

License number
Georgia CSW002378
Category
Ambulatory Health
Type
Mental Health (Including Community Mental Health Center)
Owner
Name: WAX FLOWERS
Title: LCSW/OWNER
Phone: (866) 730-7604
Address
Address
2189 W Ponce De Leon Ave, Decatur, GA 30030
National Provider ID: 1487079562
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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POSITIVE IMPACT RESIDENTIAL SERVICES, INC

2189 W Ponce De Leon Ave, Decatur, GA 30030

Industry:
Business Services Specialty Outpatient Clinic
Doing business as:
Safe Haven
Registration:
Jul 6, 2000
State ID:
0030875
Business type:
Domestic Nonprofit Corporation
Chief Financial Officers:
D Wax Flowers (CEO), 2189 W Ponce De Leon Ave, Decatur, GA 30030 (Physical),David Wax Flowers (Secretary), 2189 W Ponce De Leon Ave, Decatur, GA 30030 (Physical),Karen S. Flowers Chief Financial Officer, inactive
Agent:
Wax David Flowers Phd,2189 W Ponce De Leon Ave, Decatur, GA (Physical)

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