Bhi Outlet Inc

Primary specialty

Intellectual & Developmental Disabilities PsychologistTaxonomy code 103TM1800X

Legal business name

BHI OUTLET INC

Doing business as

Blakes House of Independence

Practice address

7450 Highway 92 Ste 120
Woodstock, GA 30189-3484

Phone

(787) 672-8656

Fax

(855) 413-6890

NPI assigned

Aug 22, 2023

Last updated

Aug 22, 2023By 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

Jamita MartinNPI 1366807778

Title

Ceo

Phone

(770) 634-9994

Specialties & licenses 2

Addresses

Other names 1

• Blakes House of Independence Doing business as

Locations

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.

• Jamita Martin

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Acworth, GA
  • NPI 1366807778
  NPD Authorized official

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

{
    "created_epoch": "1692662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692662400000",
    "number": "1215711122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7450 HIGHWAY 92 STE 120",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "301893484",
            "telephone_number": "787-672-8656",
            "fax_number": "855-413-6890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7450 HIGHWAY 92 STE 120",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "301893484",
            "telephone_number": "787-672-8656",
            "fax_number": "855-413-6890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BHI OUTLET INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-22",
        "last_updated": "2023-08-22",
        "certification_date": "2023-08-22",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "JAMITA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "770-634-9994"
    },
    "taxonomies": [
        {
            "code": "103TM1800X",
            "taxonomy_group": "",
            "desc": "Psychologist, Intellectual & Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Blakes House of Independence",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Intellectual & Developmental Disabilities Psychologist in Woodstock, GA
• Providers in Woodstock, GA by specialty
• Intellectual & Developmental Disabilities Psychologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2023; 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.