Main Street Residential Living

Primary specialty

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

Legal business name

MAIN STREET RESIDENTIAL LIVING

Doing business as

Main St
Main Street Residential Living

Practice address

615 W Main St
Thomaston, GA 30286-3580

Phone

(912) 658-9238

NPI assigned

Nov 3, 2017

Last updated

Jun 16, 2018By 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

Chrystal York

Title

Owner/Administrator

Phone

(912) 658-9238

Specialties & licenses 1

Addresses

Other names 2

• Main St Doing business as
• Main Street Residential Living Doing business as

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

{
    "created_epoch": "1509667200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529107200000",
    "number": "1568974285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3469",
            "city": "PEACHTREE CITY",
            "state": "GA",
            "postal_code": "302697469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 W MAIN ST",
            "city": "THOMASTON",
            "state": "GA",
            "postal_code": "302863580",
            "telephone_number": "912-658-9238"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN STREET RESIDENTIAL LIVING",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-03",
        "last_updated": "2018-06-16",
        "status": "A",
        "authorized_official_last_name": "YORK",
        "authorized_official_first_name": "CHRYSTAL",
        "authorized_official_title_or_position": "OWNER/ADMINISTRATOR",
        "authorized_official_telephone_number": "912-658-9238"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Main St",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Main Street Residential Living",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sabrina M. Lancaster, FNP
• Crystal H Lee, LPN
• Sybil Lew, NP
• Allison Birdsong Livingston, APRN
• Mary Street Logan, MD
• Kathy E Mansfield, MD
• Mark E. Cotney, D.C., P.C. (Thomaston Chiropractic Clinic)
• Dawn C McCoy, RD
• Jerica L. McCrary, MPA
• Baleigh McDaniel

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Thomaston, GA
• Providers in Thomaston, 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 Jun 16, 2018; 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.