License Type Code = General
License Number = 1001037
Licensee Name = SAINT LAZARUS BEHAVIORAL HEALTH INC
Business Name = SAINT LAZARUS BEHAVIORAL HEALTH INC
Business Address Line1 = 2400 NORTHSIDE XING
Business Address Line2 =
Business Address Line3 =
Business City = MACON
Business State = GA
Business Zip = 31210
Primary Phone = (478) 474-6584
Contact Name = NELLIE SAMUEL
License Status = Active
Start Of Business Date = 2016-01-12
Out Of Business Date =
Contractor = No
Application Date = 2016-01-12
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