NPIMap

Organization Active NPI

Department of Behavioral Health and Developmental Disabilities

  • Skilled Nursing Facility
  • Gracewood, GA
National Provider Identifier
1053646166
Registry record updated May 20, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
1-121-694 Issued in GA
Legal business name
DEPARTMENT OF BEHAVIORAL HEALTH AND DEVELOPMENTAL DISABILITIES
Practice address
100 Myrtle Blvd
Gracewood, GA 30812-1500
Phone
(706) 790-2042
Fax
(706) 790-2476
NPI assigned
Oct 7, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 20, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Paul Brock
Title
Regional Hospital Administrator
Phone
(706) 790-2030

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 1-121-694 GA Primary

Addresses

Primary practice location

100 Myrtle Blvd
Gracewood, GA 30812-1500

Mailing address

100 Myrtle Blvd
Gracewood, GA 30812-1500
Phone (706) 790-2030

Other identifiers 1

IdentifierTypeStateIssuer
000140709AMedicaidGA

Other names 1

  • East Central Regional Hospital Doing business as

National Provider Directory

National Provider Directory
Tax ID family
NW Ga Regional Hosp53 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 17

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 17

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1254873600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1432080000000",
    "number": "1053646166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MYRTLE BLVD",
            "city": "GRACEWOOD",
            "state": "GA",
            "postal_code": "308121500",
            "telephone_number": "706-790-2030",
            "fax_number": "706-790-2025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MYRTLE BLVD",
            "city": "GRACEWOOD",
            "state": "GA",
            "postal_code": "308121500",
            "telephone_number": "706-790-2042",
            "fax_number": "706-790-2476"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEPARTMENT OF BEHAVIORAL HEALTH AND DEVELOPMENTAL DISABILITIES",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-07",
        "last_updated": "2015-05-20",
        "status": "A",
        "authorized_official_last_name": "BROCK",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "REGIONAL HOSPITAL ADMINISTRATOR",
        "authorized_official_telephone_number": "706-790-2030",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "GA",
            "license": "1-121-694",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000140709A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "East Central Regional Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gracewood, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.