NPIMap

Organization Active NPI

Georgia Department of Human Resources

Doing business as ECRH-Gracewood Developmental Center

  • Intellectual Disabilities Intermediate Care Facility
  • Augusta, GA
National Provider Identifier
1083782288
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
2121792 Issued in GA
Legal business name
GEORGIA DEPARTMENT OF HUMAN RESOURCES
Doing business as
ECRH-Gracewood Developmental Center
Practice address
100 Myrtle Blvd
Augusta, GA 30812-1500
Phone
(706) 790-2030
NPI assigned
Dec 4, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Gail C Jackson, M.D.NPI 1417165531
Title
Regional Hospital Administrator
Phone
(706) 790-2030

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 2121792 GA Primary

Addresses

Primary practice location

100 Myrtle Blvd
Augusta, GA 30812-1500

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
00141204AMedicaidGA

Other names 1

  • ECRH-Gracewood Developmental Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1083782288. Details of each certification follow.

  • CCN 11G009 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 11G009

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
GRACEWOOD DEVELOPMENTAL CENTER ICF-IID
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Aug 1, 1976
Last certification
Dec 4, 2025
Beds
700 (63 certified)
Ownership / control type
State
Facility address
100 Myrtle Blvd- East Central Reg Hosp
Gracewood, GA 30812

National Provider Directory

National Provider Directory
Tax ID family
NW Ga Regional Hospital74 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 16

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

View all 16

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1165190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1083782288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MYRTLE BLVD",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "308121500",
            "telephone_number": "706-790-2030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MYRTLE BLVD",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "308121500",
            "telephone_number": "706-790-2030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGIA DEPARTMENT OF HUMAN RESOURCES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "GAIL",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "REGIONAL HOSPITAL ADMINISTRATOR",
        "authorized_official_telephone_number": "706-790-2030",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "GA",
            "license": "2121792",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00141204A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ECRH-Gracewood Developmental Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Augusta, GA

Sources for this page

Verify at the official NPI Registry.