NPIMap

Organization Active NPI

Pineland MH/Mr/Sa CSB

  • Clinic/Center
  • Vidalia, GA
National Provider Identifier
1760658587
Registry record updated May 1, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
LPN068072 Issued in GA
Legal business name
PINELAND MH/MR/SA CSB
Practice address
901 North St W
Vidalia, GA 30474-3503
Phone
(912) 537-9316
Fax
(912) 537-9915
NPI assigned
May 1, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 1, 2008

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

Authorized official

Name
June A Dipolito
Title
Executive Director
Phone
(912) 764-6906

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X LPN068072 GA Primary

Addresses

Primary practice location

901 North St W
Vidalia, GA 30474-3503

Mailing address

5 W Altman St
Statesboro, GA 30458-5212
Phone (912) 764-6906

National Provider Directory

National Provider Directory
Tax ID family
Pineland CSB5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

5 W Altman St
Statesboro, GA 30458
Phone (912) 764-6906

901 North St W
Vidalia, GA 30474
Phone (912) 537-9316

Practitioners & affiliated clinicians

Practitioners 1

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": "1209600000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209600000000",
    "number": "1760658587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 W ALTMAN ST",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304585212",
            "telephone_number": "912-764-6906",
            "fax_number": "912-764-3252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 NORTH ST W",
            "city": "VIDALIA",
            "state": "GA",
            "postal_code": "304743503",
            "telephone_number": "912-537-9316",
            "fax_number": "912-537-9915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINELAND MH/MR/SA CSB",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-01",
        "last_updated": "2008-05-01",
        "status": "A",
        "authorized_official_last_name": "DIPOLITO",
        "authorized_official_first_name": "JUNE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "912-764-6906"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "GA",
            "license": "LPN068072",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vidalia, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2008; 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.