NPIMap

Organization Active NPI

Willie Colquitt Host Home

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Waycross, GA
National Provider Identifier
1780126185
Registry record updated Nov 16, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X
Legal business name
WILLIE COLQUITT HOST HOME
Practice address
1007 Mary St
Waycross, GA 31503-3823
Phone
(912) 449-7109
Fax
(912) 449-7056
NPI assigned
Nov 16, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2016

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

Authorized official

Name
Michelle Simpson
Title
Billing Manager
Phone
(912) 449-7109

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X GA Primary

Addresses

Primary practice location

1007 Mary St
Waycross, GA 31503-3823

Mailing address

950 Gus Paulk Rd
Ambrose, GA 31512-3406
Phone (912) 501-7354

National Provider Directory

National Provider Directory
Tax ID family
Supportive Employment71 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1479254400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1479254400000",
    "number": "1780126185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "950 GUS PAULK RD",
            "city": "AMBROSE",
            "state": "GA",
            "postal_code": "315123406",
            "telephone_number": "912-501-7354",
            "fax_number": "912-449-7056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1007 MARY ST",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315033823",
            "telephone_number": "912-449-7109",
            "fax_number": "912-449-7056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLIE COLQUITT HOST HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-16",
        "last_updated": "2016-11-16",
        "status": "A",
        "authorized_official_last_name": "SIMPSON",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "912-449-7109"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waycross, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2016; 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.