The Cottages on Mountain Creek, LLC

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

License

PCH006602 Issued in GA

Legal business name

THE COTTAGES ON MOUNTAIN CREEK, LLC

Practice address

5815 Mountain Creek Rd NE
Sandy Springs, GA 30328-5036

Phone

(404) 228-6445

Fax

(404) 963-0555

NPI assigned

Oct 24, 2011

Last updated

Oct 24, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Carol Reynolds, MAI, CCIM

Title

Chief Executive Officer

Phone

(404) 786-4440

Specialties & licenses 3

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1319414400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1319414400000",
    "number": "1457637399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5800 MOUNTAIN CREEK RD NE",
            "city": "SANDY SPRINGS",
            "state": "GA",
            "postal_code": "303285035",
            "telephone_number": "404-228-6554",
            "fax_number": "404-963-0555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5815 MOUNTAIN CREEK RD NE",
            "city": "SANDY SPRINGS",
            "state": "GA",
            "postal_code": "303285036",
            "telephone_number": "404-228-6445",
            "fax_number": "404-963-0555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE COTTAGES ON MOUNTAIN CREEK, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-24",
        "last_updated": "2011-10-24",
        "status": "A",
        "authorized_official_last_name": "REYNOLDS",
        "authorized_official_first_name": "CAROL",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "404-786-4440",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MAI, CCIM"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "GA",
            "license": "PCH006602",
            "primary": false
        },
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "GA",
            "license": "PCH006602",
            "primary": true
        },
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": "GA",
            "license": "PCH006602",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JOINT COMMISSION HEALTH CARE",
            "identifier": "HCO520306",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rachel L Terrell-Boodram, LPC NCC
• Kaitlyn Terrell
• Jasmine Terry, LCSW
• Parth Udayan Thakker, MD, MS
• The Coh, LLC (The Circle of Health Counseling)
• The Family Health Centers of Georgia, Inc (Family Health Center @ Lake Forest)
• The Kroger Co (Kroger Pharmacy)
• The Marley-Miranda Group, Inc
• The Saul Clinic of Chiropractic
• The Tree of Knowledge

• Mental Illness Community Based Residential Treatment Facility in Sandy Springs, GA
• Providers in Sandy Springs, GA by specialty
• Mental Illness Community Based Residential Treatment Facility in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2011; 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.