Shane's Crib

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

License

CSW003662 Issued in GA

Legal business name

SHANE'S CRIB

Practice address

1303 South 1St Street
Jesup, GA 31545

Phone

(912) 385-2583

Fax

(912) 385-2583

NPI assigned

Feb 12, 2015

Last updated

Feb 12, 2015By the provider in NPPES

Organization subpart

Yes

Parent organization

MASA TAKE BY FORCE MINISTRIESAs reported in NPPES

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

Authorized official

Name

Mrs. Cheryl E Mainor, LPC

Title

Director

Phone

(912) 385-2583

Specialties & licenses 1

Addresses

Part of

Shane's Crib

Locations

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

{
    "created_epoch": "1423699200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1423699200000",
    "number": "1386035335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1303 S 1ST ST",
            "city": "JESUP",
            "state": "GA",
            "postal_code": "315457757",
            "telephone_number": "912-385-2583",
            "fax_number": "912-385-2583"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1303 SOUTH 1ST STREET",
            "city": "JESUP",
            "state": "GA",
            "postal_code": "31545",
            "telephone_number": "912-385-2583",
            "fax_number": "912-385-2583"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHANE'S CRIB",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MASA TAKE BY FORCE MINISTRIES",
        "enumeration_date": "2015-02-12",
        "last_updated": "2015-02-12",
        "status": "A",
        "authorized_official_last_name": "MAINOR",
        "authorized_official_first_name": "CHERYL",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "912-385-2583",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "GA",
            "license": "CSW003662",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Substance Abuse Rehabilitation Facility in Jesup, GA
• Providers in Jesup, GA by specialty
• Substance Abuse Rehabilitation Facility in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2015; 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.