NPIMap

Organization Active NPI

River Edge Behavioral Health Center

Doing business as River Edge Baldwin County

  • Community/Retail Pharmacy
  • Milledgeville, GA
National Provider Identifier
1306117999
Registry record updated Dec 22, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PHRE009803 Issued in GA
Legal business name
RIVER EDGE BEHAVIORAL HEALTH CENTER
Doing business as
River Edge Baldwin County
Practice address
60 Ga Highway 22 W
Milledgeville, GA 31061-6606
Phone
(478) 451-2784
Fax
(478) 454-3131
NPI assigned
Jan 13, 2012
Last updated
Dec 22, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2016

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

Authorized official

Name
Bryan Layman
Title
Pharmacy Director
Phone
(478) 451-2784

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X PHRE009803 GA Primary

Addresses

Primary practice location

60 Ga Highway 22 W
Milledgeville, GA 31061-6606

Mailing address

60 Ga Highway 22 W
Milledgeville, GA 31061-6606
Phone (478) 451-2784

Other identifiers 2

IdentifierTypeStateIssuer
2133695OtherPK
000604986BMedicaidGA

Other names 1

  • River Edge Baldwin County Doing business as

National Provider Directory

National Provider Directory
Tax ID family
River Edge Behavorial H77 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

60 GA Highway 22 W
Milledgeville, GA 31061
Phone (478) 414-1414

NPI Registry JSON

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

{
    "created_epoch": "1326412800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1482364800000",
    "number": "1306117999",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "60 GA HIGHWAY 22 W",
            "city": "MILLEDGEVILLE",
            "state": "GA",
            "postal_code": "310616606",
            "telephone_number": "478-451-2784",
            "fax_number": "478-454-3131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 GA HIGHWAY 22 W",
            "city": "MILLEDGEVILLE",
            "state": "GA",
            "postal_code": "310616606",
            "telephone_number": "478-451-2784",
            "fax_number": "478-454-3131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVER EDGE BEHAVIORAL HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-13",
        "last_updated": "2016-12-22",
        "status": "A",
        "authorized_official_last_name": "LAYMAN",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_title_or_position": "PHARMACY DIRECTOR",
        "authorized_official_telephone_number": "478-451-2784"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "GA",
            "license": "PHRE009803",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2133695",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000604986B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "River Edge Baldwin County",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Milledgeville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2016; 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.