NPIMap

Organization Active NPI

Ginger Ridge Behavioral Health, LLC

  • Adult Mental Health Clinic/Center
  • Fayetteville, GA
National Provider Identifier
1336424787
Registry record updated Jan 24, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X
License
CSW004018 Issued in GA
Legal business name
GINGER RIDGE BEHAVIORAL HEALTH, LLC
Practice address
170 Bastille Way Ste C
Fayetteville, GA 30214-7652
Phone
(770) 461-7010
Fax
(770) 461-7100
NPI assigned
Oct 17, 2011
Last updated
Jan 24, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2012

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

Authorized official

Name
Dr. Claudette Idigo, L.C.S.W,
Title
Clinical Social Worker
Phone
(678) 428-1728

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X CSW004018 GA
Developmental Disabilities Clinic/Center 261QD1600X CSW004018 GA
Adult Mental Health Clinic/Center 261QM0850X CSW004018 GA Primary
Adolescent and Children Mental Health Clinic/Center 261QM0855X CSW004018 GA
Community/Behavioral Health Agency 251S00000X CSW004018 GA

Addresses

Primary practice location

170 Bastille Way Ste C
Fayetteville, GA 30214-7652

Mailing address

170 Bastille Way Ste C
Fayetteville, GA 30214-7652
Phone (770) 461-7010

National Provider Directory

National Provider Directory

Locations

170 Bastille Way
Ste C
Fayetteville, GA 30214
Phone (770) 461-7010

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1318809600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1327363200000",
    "number": "1336424787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "170 BASTILLE WAY STE C",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302147652",
            "telephone_number": "770-461-7010",
            "fax_number": "770-461-7100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "170 BASTILLE WAY STE C",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302147652",
            "telephone_number": "770-461-7010",
            "fax_number": "770-461-7100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GINGER RIDGE BEHAVIORAL HEALTH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-17",
        "last_updated": "2012-01-24",
        "status": "A",
        "authorized_official_last_name": "IDIGO",
        "authorized_official_first_name": "CLAUDETTE",
        "authorized_official_title_or_position": "CLINICAL SOCIAL WORKER",
        "authorized_official_telephone_number": "678-428-1728",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "L.C.S.W,"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "GA",
            "license": "CSW004018",
            "primary": false
        },
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": "GA",
            "license": "CSW004018",
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "GA",
            "license": "CSW004018",
            "primary": true
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "GA",
            "license": "CSW004018",
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "GA",
            "license": "CSW004018",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2012; 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.