NPIMap

Organization Active NPI

Clayton Center

Doing business as Clayton Center Holly Tree 101

  • Mental Illness Community Based Residential Treatment Facility
  • Riverdale, GA
National Provider Identifier
1760999643
Registry record updated Jun 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
Legal business name
CLAYTON CENTER
Doing business as
Clayton Center Holly Tree 101
Clayton Center Holly Tree 104
Practice address
5930 Highway 85 Unit 104
Riverdale, GA 30274-1502
Phone
(770) 997-8137
NPI assigned
Jan 2, 2018
Organization subpart
Yes
Parent organization
CLAYTON CENTER MHADDDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 16, 2018

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

Authorized official

Name
Tiffany Tom-Johnson
Title
Coo
Phone
(770) 478-2280

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X Primary

Addresses

Primary practice location

5930 Highway 85 Unit 104
Riverdale, GA 30274-1502

Mailing address

157 Smith St
Jonesboro, GA 30236-3546
Phone (770) 473-2649

Other practice location 1

5930 Highway 85 Unit 101
Riverdale, GA 30274-1502
Phone (770) 997-8137

Other names 2

  • Clayton Center Holly Tree 101 Doing business as
  • Clayton Center Holly Tree 104 Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Clayton Mhddad34 organizations share this tax ID, including this one
Part of
Clayton Mhddad

Other organizations with this tax ID 33

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

View all 33

NPI Registry JSON

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

{
    "created_epoch": "1514851200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529107200000",
    "number": "1760999643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "157 SMITH ST",
            "city": "JONESBORO",
            "state": "GA",
            "postal_code": "302363546",
            "telephone_number": "770-473-2649"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5930 HIGHWAY 85 UNIT 104",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "302741502",
            "telephone_number": "770-997-8137"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5930 Highway 85 Unit 101",
            "address_purpose": "LOCATION",
            "city": "Riverdale",
            "state": "GA",
            "postal_code": "302741502",
            "country_code": "US",
            "telephone_number": "770-997-8137",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CLAYTON CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CLAYTON CENTER MHADDD",
        "enumeration_date": "2018-01-02",
        "last_updated": "2018-06-16",
        "status": "A",
        "authorized_official_last_name": "TOM-JOHNSON",
        "authorized_official_first_name": "TIFFANY",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "770-478-2280"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clayton Center Holly Tree 101",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Clayton Center Holly Tree 104",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jun 16, 2018; 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.