NPIMap

Organization Active NPI

Georgia Department of Human Resources

Doing business as Gracewood Community Services

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Hephzibah, GA
National Provider Identifier
1568530798
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X
Legal business name
GEORGIA DEPARTMENT OF HUMAN RESOURCES
Doing business as
Gracewood Community Services
Practice address
3533 Stafford St
Hephzibah, GA 30815-6625
Phone
(706) 790-2034
NPI assigned
Dec 4, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Gail C Jackson, M.D.
Title
Regional Hospital Administrator
Phone
(706) 790-2030

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X GA Primary

Addresses

Primary practice location

3533 Stafford St
Hephzibah, GA 30815-6625

Mailing address

100 Myrtle Blvd
Gracewood, GA 30812-1500
Phone (706) 790-2030

Other names 1

  • Gracewood Community Services Doing business as

National Provider Directory

National Provider Directory
Tax ID family
NW Ga Regional Hospital74 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1165190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1568530798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MYRTLE BLVD",
            "city": "GRACEWOOD",
            "state": "GA",
            "postal_code": "308121500",
            "telephone_number": "706-790-2030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3533 STAFFORD ST",
            "city": "HEPHZIBAH",
            "state": "GA",
            "postal_code": "308156625",
            "telephone_number": "706-790-2034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGIA DEPARTMENT OF HUMAN RESOURCES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "GAIL",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "REGIONAL HOSPITAL ADMINISTRATOR",
        "authorized_official_telephone_number": "706-790-2030",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gracewood Community Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hephzibah, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.