NPIMap

Organization Active NPI

Tri-State Treatment,LLC

  • Substance Abuse Rehabilitation Facility
  • Wildwood, GA
National Provider Identifier
1780036210
Registry record updated Mar 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
License
NTP001071 Issued in GA
Legal business name
TRI-STATE TREATMENT,LLC
Practice address
1236 Highway 299
Wildwood, GA 30757-4003
Phone
(423) 428-0045
Fax
(423) 428-0046
NPI assigned
Jul 8, 2016
Last updated
Mar 20, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2024

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

Authorized official

Name
Melissa M Hancock
Title
Administrator
Phone
(423) 428-0045

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X NTP001071 GA Primary

Addresses

Primary practice location

1236 Highway 299
Wildwood, GA 30757-4003

Mailing address

1236 Highway 299
Wildwood, GA 30757-4003
Phone (423) 428-0045

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Opioid treatment program
Medicare-enrolled since Jan 4, 2020

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200313000816 GA Part B Supplier - Opioid Treatment Program (Otp) 0840628434 Practice locations: Wildwood, GA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D2136124Tri-State Treatment1236 Highway 299, Wildwood, GA 30757Certificate of waiverSep 4, 2027

National Provider Directory

National Provider Directory

Locations

1236 Highway 299
Wildwood, GA 30757
Phone (423) 428-0045

Practitioners & affiliated clinicians

Practitioners 11

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": "1467936000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710892800000",
    "number": "1780036210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1236 HIGHWAY 299",
            "city": "WILDWOOD",
            "state": "GA",
            "postal_code": "307574003",
            "telephone_number": "423-428-0045",
            "fax_number": "423-428-0046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1236 HIGHWAY 299",
            "city": "WILDWOOD",
            "state": "GA",
            "postal_code": "307574003",
            "telephone_number": "423-428-0045",
            "fax_number": "423-428-0046"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI-STATE TREATMENT,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-08",
        "last_updated": "2024-03-20",
        "certification_date": "2024-03-20",
        "status": "A",
        "authorized_official_last_name": "HANCOCK",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "423-428-0045"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "GA",
            "license": "NTP001071",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wildwood, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.