NPIMap

Organization Active NPI

River Edge Behavioral Health Center

  • Community/Behavioral Health Agency
  • Macon, GA
National Provider Identifier
1174512966
Registry record updated May 5, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
RIVER EDGE BEHAVIORAL HEALTH CENTER
Practice address
175 Emery Hwy
Macon, GA 31217-3692
Phone
(478) 751-4519
NPI assigned
Oct 14, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 5, 2008

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

Authorized official

Name
Mrs. Beth Tyler
Title
Chief Financial Officer
Phone
(478) 752-3231

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

175 Emery Hwy
Macon, GA 31217-3692

Mailing address

175 Emery Hwy
Macon, GA 31217-3692
Phone (478) 751-4519

Other identifiers 1

IdentifierTypeStateIssuer
000604194EMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040414000303 GA Part B Supplier - Clinic/Group Practice 1153315874 Receives reassigned benefits from 14 practitioners
Practice locations: Atlanta, GA; Macon, GA; Sandy Springs, GA

National Provider Directory

National Provider Directory
Tax ID family
Chigorziri D Umuna77 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

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

View all 24

Locations

5590 Stonewall Tell Rd
Atlanta, GA 30349
Phone (404) 665-8700

7741 Roswell Rd
Sandy Springs, GA 30350
Phone (404) 612-2273

Practitioners & affiliated clinicians

Practitioners 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1129248000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209945600000",
    "number": "1174512966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "175 EMERY HWY",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312173692",
            "telephone_number": "478-751-4519"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 EMERY HWY",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312173692",
            "telephone_number": "478-751-4519"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVER EDGE BEHAVIORAL HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-14",
        "last_updated": "2008-05-05",
        "status": "A",
        "authorized_official_last_name": "TYLER",
        "authorized_official_first_name": "BETH",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "478-752-3231",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000604194E",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Macon, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.