NPIMap

Organization Active NPI

CSB of East Central Ga

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Warrenton, GA
National Provider Identifier
1194056879
Registry record updated Jan 20, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X
Legal business name
CSB OF EAST CENTRAL GA
Practice address
236 Main St
Warrenton, GA 30828-8100
Phone
(706) 432-4858
Fax
(706) 432-3780
NPI assigned
Jan 20, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2010

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

Authorized official

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

Specialties & licenses 1

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

Addresses

Primary practice location

236 Main St
Warrenton, GA 30828-8100

Mailing address

3421 Mike Padgett Hwy
Augusta, GA 30906-3815

Other identifiers 1

IdentifierTypeStateIssuer
000927693AFMedicaidGA

Other names 1

  • GULLEY PCH Doing business as

National Provider Directory

National Provider Directory
Tax ID family
CSB of East Central Ga49 organizations share this tax ID, including this one

Other organizations with this tax ID 48

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

View all 48

NPI Registry JSON

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

{
    "created_epoch": "1263945600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1263945600000",
    "number": "1194056879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3421 MIKE PADGETT HWY",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309063815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "236 MAIN ST",
            "city": "WARRENTON",
            "state": "GA",
            "postal_code": "308288100",
            "telephone_number": "706-432-4858",
            "fax_number": "706-432-3780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CSB OF EAST CENTRAL GA",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-20",
        "last_updated": "2010-01-20",
        "status": "A",
        "authorized_official_last_name": "JESSIE",
        "authorized_official_first_name": "WANDA",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "706-432-4858"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000927693AF",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GULLEY PCH",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Warrenton, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2010; 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.