Southern Community Services Inc

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

034-01-019-8 Issued in GA

Legal business name

SOUTHERN COMMUNITY SERVICES INC

Practice address

315 S. Gaskin Ave
Douglas, GA 31533

Phone

(912) 393-3466

Fax

(912) 393-1103

NPI assigned

Jul 25, 2008

Organization subpart

No

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

Authorized official

Name

Mrs. Lisa Moore

Title

Manager

Phone

(912) 393-3466

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1216944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216944000000",
    "number": "1417112707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "315 S. GASKIN AVE",
            "city": "DOUGLAS",
            "state": "GA",
            "postal_code": "31533",
            "telephone_number": "912-393-3466",
            "fax_number": "912-393-1103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 S. GASKIN AVE",
            "city": "DOUGLAS",
            "state": "GA",
            "postal_code": "31533",
            "telephone_number": "912-393-3466",
            "fax_number": "912-393-1103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN COMMUNITY SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-25",
        "last_updated": "2008-07-25",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "912-393-3466",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "GA",
            "license": "034-01-019-8",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "290464766A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Douglas, GA
• Providers in Douglas, GA by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2008; 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.