Bertha Richardsaon

Organization Active NPI Community/Behavioral Health Agency · Waycross, GA

NPI 1770855868 · NPPES record last updated Feb 3, 2012

Key facts

NPI
1770855868
Entity type
Organization (NPI type 2)
Primary specialty
Community/Behavioral Health Agency 251S00000X
Legal business name
BERTHA RICHARDSAON
Practice address
1614 Carswell Ave
Waycross, GA 31503
Phone
(912) 285-5171
Fax
(912) 449-7111
NPI assigned
Feb 3, 2012
Organization subpart
Yes
Parent organization (as reported)
SATILLA COMMUNITY SERVICES

Authorized official

Name
Bobby Brown
Title
Ceo
Phone
(912) 449-7111

Corporate family (same tax ID) 24

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

National Provider Directory

Tax ID family
Supportive Employment (71 organizations share this tax ID)
Part of
Supportive Employment

Locations

1614 Carswell Ave
Waycross, GA 31503
Phone (912) 285-5171

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Yes

Addresses

Primary practice location

1614 Carswell Ave
Waycross, GA 31503

Mailing address

1007 Mary St
Waycross, GA 31503-3823
Phone (912) 449-7111

Other providers in Waycross, GA

All providers in Waycross, GA · Community/Behavioral Health Agency in Georgia

Sources for this page

Verify at the official NPI Registry.