NPIMap

Organization Active NPI

Camellia Therapeutic Foster Agency LLC

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Phenix City, AL
National Provider Identifier
1295064269
Registry record updated Dec 21, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
License
034627 Issued in AL
Legal business name
CAMELLIA THERAPEUTIC FOSTER AGENCY LLC
Practice address
407 S Seale Rd
Phenix City, AL 36869-7304
Phone
(706) 392-3331
Fax
(334) 298-8599
NPI assigned
Dec 21, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2009

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

Authorized official

Name
Dr. Joseph Appiah
Title
Chief Executive Officer
Phone
(706) 392-3331

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X 034627 AL Primary

Addresses

Primary practice location

407 S Seale Rd
Phenix City, AL 36869-7304

Mailing address

407 S Seale Rd
P.O. Box 788
Phenix City, AL 36869-7304
Phone (706) 392-3331

Other identifiers 3

IdentifierTypeStateIssuer
339089024MedicaidAL
339091202OtherALEDS/SDHR339000000
339091102OtherALEDS/SDHR339000000

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1261353600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1261353600000",
    "number": "1295064269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "407 S SEALE RD",
            "address_2": "P.O. BOX 788",
            "city": "PHENIX CITY",
            "state": "AL",
            "postal_code": "368697304",
            "telephone_number": "706-392-3331",
            "fax_number": "334-298-8599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "407 S SEALE RD",
            "city": "PHENIX CITY",
            "state": "AL",
            "postal_code": "368697304",
            "telephone_number": "706-392-3331",
            "fax_number": "334-298-8599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAMELLIA THERAPEUTIC FOSTER AGENCY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-21",
        "last_updated": "2009-12-21",
        "status": "A",
        "authorized_official_last_name": "APPIAH",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "706-392-3331",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "AL",
            "license": "034627",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "339089024",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EDS/SDHR339000000",
            "identifier": "339091202",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EDS/SDHR339000000",
            "identifier": "339091102",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phenix City, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 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.