Bobby Bennett Host Home
Organization Active NPI Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Waycross, GA
NPI 1639495682 · NPPES record last updated Apr 15, 2010
Key facts
- NPI
- 1639495682
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X
- Legal business name
- BOBBY BENNETT HOST HOME
- Practice address
- 1007 Mary St
Waycross, GA 31503-3823 - Phone
- (912) 449-7111
- NPI assigned
- Apr 15, 2010
- Organization subpart
- Yes
- Parent organization (as reported)
- SATILLA COMMUNITY SERVICES
Authorized official
- Name
- Glynn Thomas, PHD
- Title
- Ceo
- Phone
- (912) 449-7103
Corporate family (same tax ID) 24
National Provider Directory
- Tax ID family
- Supportive Employment
- Part of
- Supportive Employment
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility | 320900000X | Yes |
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
- Satilla Community Services
Other providers in Waycross, GA
- Blackwell Dynamics LLC
- James Madison Blackwell
- Scotty Blanchard Jr.
- Hazel Blaylock-Lawson
- James H Bloodworth
- Lydia C Boggs
- Tiffany L Bolden-Watkins
- Yolanda Machelle Borders
- Drew Robert Borgholthaus
- Deena M. Boyd
All providers in Waycross, GA · Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 15, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.