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Georgia Department of Human Resources

Organization Active NPI Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Hephzibah, GA

NPI 1316015308 · NPPES record last updated Aug 22, 2020

Key facts

NPI
1316015308
Entity type
Organization (NPI type 2)
Primary specialty
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X
Legal business name
GEORGIA DEPARTMENT OF HUMAN RESOURCES
Practice address
2577 Lincolnton Pkwy
Hephzibah, GA 30815-5932
Phone
(706) 790-2034
NPI assigned
Nov 30, 2006
Organization subpart
No

Authorized official

Name
Dr. Gail C Jackson, M.D.
Title
Regional Hospital Administrator
Phone
(706) 790-2030

Corporate family (same tax ID) 24

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

National Provider Directory

Tax ID family
Roosevelt Warm SGP Inst (74 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X GA Yes

Addresses

Primary practice location

2577 Lincolnton Pkwy
Hephzibah, GA 30815-5932

Mailing address

100 Myrtle Blvd
Gracewood, GA 30812-1500
Phone (706) 790-2030

Other names

  • Gracewood Community Services Doing business as

Other providers in Hephzibah, GA

All providers in Hephzibah, GA · Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Georgia

Sources for this page

Verify at the official NPI Registry.