NPIMap

Organization Active NPI

Department of Behavioral Health and Developmental Disabilities

Doing business as East Central Regional Hospital

  • Intellectual Disabilities Intermediate Care Facility
  • Gracewood, GA
National Provider Identifier
1699000703
Registry record updated May 20, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
2-121-792 Issued in GA
Legal business name
DEPARTMENT OF BEHAVIORAL HEALTH AND DEVELOPMENTAL DISABILITIES
Doing business as
East Central Regional Hospital
Practice address
100 Myrtle Blvd
Gracewood, GA 30812-1500
Phone
(706) 790-2030
Fax
(706) 790-2025
NPI assigned
Oct 7, 2009
Last updated
May 20, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 20, 2015

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

Authorized official

Name
Mr. Paul Brock
Title
Regional Hospital Administrator
Phone
(706) 790-2030

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 2-121-792 GA Primary

Addresses

Primary practice location

100 Myrtle Blvd
Gracewood, GA 30812-1500

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
000141204AMedicaidGA

Other names 1

  • East Central Regional Hospital Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Department of Behavioral Health Developmental Disabilities Ga53 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

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1254873600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1432080000000",
    "number": "1699000703",
    "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",
            "fax_number": "706-790-2025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MYRTLE BLVD",
            "city": "GRACEWOOD",
            "state": "GA",
            "postal_code": "308121500",
            "telephone_number": "706-790-2030",
            "fax_number": "706-790-2025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEPARTMENT OF BEHAVIORAL HEALTH AND DEVELOPMENTAL DISABILITIES",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-07",
        "last_updated": "2015-05-20",
        "status": "A",
        "authorized_official_last_name": "BROCK",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "REGIONAL HOSPITAL ADMINISTRATOR",
        "authorized_official_telephone_number": "706-790-2030",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "GA",
            "license": "2-121-792",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000141204A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "East Central Regional Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gracewood, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2015; 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.