Southwestern State Hospital
Organization Active NPI Mental Illness Community Based Residential Treatment Facility · Thomasville, GA
NPI 1376645796 · NPPES record last updated Aug 18, 2009
Key facts
- NPI
- 1376645796
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Mental Illness Community Based Residential Treatment Facility 320800000X
- License
- 58-1130678 (GA)
- Legal business name
- SOUTHWESTERN STATE HOSPITAL
- Practice address
- 307 Cloverdale Dr
Intensive Treatment Residence Program
Thomasville, GA 31792-4018 - Phone
- (229) 227-2977
- Fax
- (229) 227-2955
- NPI assigned
- Sep 5, 2006
- Organization subpart
- No
Authorized official
- Name
- Mrs. Hilary J Hoo-You
- Title
- Regional Hospital Administrator
- Phone
- (229) 227-3021
Corporate family (same tax ID) 24
National Provider Directory
- Tax ID family
- NW Ga Regional Hosp
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Illness Community Based Residential Treatment Facility | 320800000X | 58-1130678 | GA | Yes |
Addresses
Primary practice location
307 Cloverdale Dr
Intensive Treatment Residence Program
Thomasville, GA 31792-4018
Mailing address
PO Box 1378
Patient Billing Dept
Thomasville, GA 31799-1378
Phone (229) 227-2977
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 252378193A | Medicaid | GA |
Other names
- Intensive Treatment Residence Program
Other providers in Thomasville, GA
- Southland Emergency Medical Services, L.L.C
- Southland Hospitalist Group, LLC
- Southwestern State Hospital
- Southwestern State Hospital
- Southwestern State Hospital
- Southwestern State Hospital
- Southwestern State Hospital
- Southwestern State Hospital
- Southwestern State Hospital
- Southwestern State Hospital
All providers in Thomasville, GA · Mental Illness 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 18, 2009. 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.