Hapeville Manor Assisted Living Facility, Inc

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

060030111 Issued in GA

Legal business name

HAPEVILLE MANOR ASSISTED LIVING FACILITY, INC

Practice address

601 Coleman St
Hapeville, GA 30354-1041

Phone

(404) 767-5874

Fax

(404) 305-9461

NPI assigned

Dec 8, 2011

Last updated

Dec 8, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Carlton S. Watt

Title

Ceo

Phone

(404) 767-5874

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1323302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323302400000",
    "number": "1083982797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3752 PRESCOTT RIDGE CIR",
            "city": "CLARKSTON",
            "state": "GA",
            "postal_code": "300211664",
            "telephone_number": "404-767-5874",
            "fax_number": "404-305-9461"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 COLEMAN ST",
            "city": "HAPEVILLE",
            "state": "GA",
            "postal_code": "303541041",
            "telephone_number": "404-767-5874",
            "fax_number": "404-305-9461"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAPEVILLE MANOR ASSISTED LIVING FACILITY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-08",
        "last_updated": "2011-12-08",
        "status": "A",
        "authorized_official_last_name": "WATT",
        "authorized_official_first_name": "CARLTON",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "404-767-5874",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "GA",
            "license": "060030111",
            "primary": false
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "GA",
            "license": "060030111",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Hapeville, GA
• Providers in Hapeville, GA by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2011; 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.