NPIMap

Organization Active NPI

Willow Oak Community Behavioral Health Center, Inc.

  • Community/Behavioral Health Agency
  • Riverdale, GA
National Provider Identifier
1740936335
Registry record updated Feb 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
WILLOW OAK COMMUNITY BEHAVIORAL HEALTH CENTER, INC.
Practice address
6944 Highway 85 Ste F
Riverdale, GA 30274-2960
Phone
(770) 683-6946
Fax
(779) 683-6949
NPI assigned
Feb 23, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2024

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

Authorized official

Name
Diane BoulaiNPI 1437442803
Title
Ceo
Phone
(678) 477-3476

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Integrative Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 202D00000X
Community/Behavioral Health Agency 251S00000X Primary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X

Addresses

Primary practice location

6944 Highway 85 Ste F
Riverdale, GA 30274-2960

Mailing address

361 Cliffhaven Cir
Newnan, GA 30263-6358
Phone (678) 477-3476

National Provider Directory

National Provider Directory
Tax ID family
Willow Oak Comm BH Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1645574400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707696000000",
    "number": "1740936335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "361 CLIFFHAVEN CIR",
            "city": "NEWNAN",
            "state": "GA",
            "postal_code": "302636358",
            "telephone_number": "678-477-3476",
            "fax_number": "770-683-6949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6944 HIGHWAY 85 STE F",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "302742960",
            "telephone_number": "770-683-6946",
            "fax_number": "779-683-6949"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOW OAK COMMUNITY BEHAVIORAL HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-23",
        "last_updated": "2024-02-12",
        "certification_date": "2024-02-12",
        "status": "A",
        "authorized_official_last_name": "BOULAI",
        "authorized_official_first_name": "DIANE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "678-477-3476"
    },
    "taxonomies": [
        {
            "code": "202D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Integrative Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverdale, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2024; 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.