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CSB of East Central Ga

Organization Active NPI Intellectual and/or Developmental Disabilities Residential Treatment Facility · Thomson, GA

NPI 1114258753 · NPPES record last updated Jan 21, 2010

Key facts

NPI
1114258753
Entity type
Organization (NPI type 2)
Primary specialty
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X
Legal business name
CSB OF EAST CENTRAL GA
Practice address
1669 Carolyn Lake Cir
Thomson, GA 30824-4523
Phone
(706) 432-4858
Fax
(706) 432-3780
NPI assigned
Jan 21, 2010
Organization subpart
No

Authorized official

Name
Wanda Jessie
Title
Billing Manager
Phone
(706) 432-4858

Corporate family (same tax ID) 48

Organizations that report the same tax identification number in the National Provider Directory.

View all 48

National Provider Directory

Tax ID family
CSB of East Central Ga (49 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X Yes

Addresses

Primary practice location

1669 Carolyn Lake Cir
Thomson, GA 30824-4523

Mailing address

3421 Mike Padgett Hwy
Augusta, GA 30906-3815

Other identifiers

IdentifierTypeStateIssuer
000927693ABMedicaidGA

Other names

  • HEINHOLD PCH Doing business as

Other providers in Thomson, GA

All providers in Thomson, GA · Intellectual and/or Developmental Disabilities Residential Treatment Facility in Georgia

Sources for this page

Verify at the official NPI Registry.