NPIMap

Organization Active NPI

Southwestern State Hospital

Doing business as Rose Haven ICF/MR

  • Intellectual Disabilities Intermediate Care Facility
  • Thomasville, GA
National Provider Identifier
1215920525
Registry record updated Aug 18, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
2-136-832 Issued in GA
Legal business name
SOUTHWESTERN STATE HOSPITAL
Doing business as
Rose Haven ICF/MR
Practice address
400 S Pinetree Blvd
Thomasville, GA 31792-7128
Phone
(229) 227-3004
Fax
(227) 227-2663
NPI assigned
Aug 23, 2005
Last updated
Aug 18, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2009

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

Authorized official

Name
Mrs. Hilary J Hoo-You
Title
Regional Hospital Administrator
Phone
(229) 227-3020

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 2-136-832 GA Primary

Addresses

Primary practice location

400 S Pinetree Blvd
Thomasville, GA 31792-7128

Mailing address

PO Box 1378
Patient Billing Dept
Thomasville, GA 31799-1378
Phone (229) 227-3004

Other identifiers 1

IdentifierTypeStateIssuer
00142799AMedicaidGA

Other names 1

  • Rose Haven ICF/MR Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Department of Behavioral Health Developmental Disabilities Ga53 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

NPI Registry JSON

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

{
    "created_epoch": "1124755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1250553600000",
    "number": "1215920525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1378",
            "address_2": "PATIENT BILLING DEPT",
            "city": "THOMASVILLE",
            "state": "GA",
            "postal_code": "317991378",
            "telephone_number": "229-227-3004",
            "fax_number": "227-227-2663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 S PINETREE BLVD",
            "city": "THOMASVILLE",
            "state": "GA",
            "postal_code": "317927128",
            "telephone_number": "229-227-3004",
            "fax_number": "227-227-2663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWESTERN STATE HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-23",
        "last_updated": "2009-08-18",
        "status": "A",
        "authorized_official_last_name": "HOO-YOU",
        "authorized_official_first_name": "HILARY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "REGIONAL HOSPITAL ADMINISTRATOR",
        "authorized_official_telephone_number": "229-227-3020",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "GA",
            "license": "2-136-832",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00142799A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rose Haven ICF/MR",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Thomasville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2009; 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.