Georgia Department of Human Resources
Organization Active NPI Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Augusta, GA
NPI 1366510067 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1366510067
- 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
- 2311 Mura Dr
Augusta, GA 30906-4819 - Phone
- (706) 790-2034
- NPI assigned
- Dec 1, 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
National Provider Directory
- Tax ID family
- Roosevelt Warm SGP Inst
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility | 320900000X | GA | Yes |
Addresses
Primary practice location
2311 Mura Dr
Augusta, GA 30906-4819
Mailing address
100 Myrtle Blvd
Gracewood, GA 30812-1500
Phone (706) 790-2030
Other names
- Gracewood Community Services
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All providers in Augusta, GA · Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.