NPIMap

Organization Active NPI

Bobby Bennett Host Home

Doing business as Satilla Community Services

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Waycross, GA
National Provider Identifier
1639495682
Registry record updated Apr 15, 2010
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
BOBBY BENNETT HOST HOME
Doing business as
Satilla Community Services
Practice address
1007 Mary St
Waycross, GA 31503-3823
Phone
(912) 449-7111
NPI assigned
Apr 15, 2010
Last updated
Apr 15, 2010By the provider in NPPES
Organization subpart
Yes
Parent organization
SATILLA COMMUNITY SERVICESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 15, 2010

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

Authorized official

Name
Glynn Thomas, PHD
Title
Ceo
Phone
(912) 449-7103

Specialties & licenses 1

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

Addresses

Primary practice location

1007 Mary St
Waycross, GA 31503-3823

Mailing address

4156 White Tail Way
Blackshear, GA 31516-5204
Phone (912) 449-8601

Other names 1

  • Satilla Community Services Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Ernestine Nelson71 organizations share this tax ID, including this one
Part of
Ernestine Nelson

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": "1271289600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1271289600000",
    "number": "1639495682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4156 WHITE TAIL WAY",
            "city": "BLACKSHEAR",
            "state": "GA",
            "postal_code": "315165204",
            "telephone_number": "912-449-8601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1007 MARY ST",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315033823",
            "telephone_number": "912-449-7111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOBBY BENNETT HOST HOME",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SATILLA COMMUNITY SERVICES",
        "enumeration_date": "2010-04-15",
        "last_updated": "2010-04-15",
        "status": "A",
        "authorized_official_last_name": "THOMAS",
        "authorized_official_first_name": "GLYNN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "912-449-7103",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Satilla Community Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Waycross, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2010; 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.