NPIMap

Organization Active NPI

Dekalb Community Service Board

  • Community/Behavioral Health Agency
  • Tucker, GA
National Provider Identifier
1497890214
Registry record updated Apr 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
DEKALB COMMUNITY SERVICE BOARD
Practice address
4200 Waterloo Cir
Tucker, GA 30084-2237
Phone
(770) 270-0160
Fax
(770) 270-0160
NPI assigned
Feb 20, 2007
Last updated
Apr 24, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
DEKALB COMMUNITY SERVICE BOARDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 24, 2020

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

Authorized official

Name
Fabio Bruno Van Der Merwe
Title
Coo
Phone
(404) 294-3836

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X NU Primary

Addresses

Primary practice location

4200 Waterloo Cir
Tucker, GA 30084-2237

Mailing address

445 Winn Way FL 4
Decatur, GA 30030-1707
Phone (404) 294-3836

Other names 1

  • Waterloo Group Home Other name

National Provider Directory

National Provider Directory
Tax ID family
Dekalb Community SVC BD24 organizations share this tax ID, including this one
Part of
Dekalb Community SVC BD

Other organizations with this tax ID 23

Organizations that report the same tax identification number in the National Provider Directory.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1171929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1587686400000",
    "number": "1497890214",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "445 WINN WAY FL 4",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300301707",
            "telephone_number": "404-294-3836"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4200 WATERLOO CIR",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "300842237",
            "telephone_number": "770-270-0160",
            "fax_number": "770-270-0160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEKALB COMMUNITY SERVICE BOARD",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DEKALB COMMUNITY SERVICE BOARD",
        "enumeration_date": "2007-02-20",
        "last_updated": "2020-04-24",
        "certification_date": "2020-04-24",
        "status": "A",
        "authorized_official_last_name": "VAN DER MERWE",
        "authorized_official_first_name": "FABIO",
        "authorized_official_middle_name": "BRUNO",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "404-294-3836"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Waterloo Group Home",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Tucker, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2020; 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.