NPIMap

Organization Active NPI

Cobb Community Services Board

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Marietta, GA
National Provider Identifier
1801133459
Registry record updated Jan 15, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X
Legal business name
COBB COMMUNITY SERVICES BOARD
Practice address
218 South Ave SE
Marietta, GA 30060-2384
Phone
(770) 429-5020
Fax
(678) 213-1450
NPI assigned
Jan 15, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2013

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

Authorized official

Name
Mr. Tod Citron, LCSW
Title
Ceo
Phone
(770) 429-5000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X Primary

Addresses

Primary practice location

218 South Ave SE
Marietta, GA 30060-2384

Mailing address

3830 S Cobb Dr SE
Suite 300
Smyrna, GA 30080-5532
Phone (770) 429-5020

Other identifiers 1

IdentifierTypeStateIssuer
000599783QMedicaidGA

Other names 1

  • Annette Carter Home Other name

National Provider Directory

National Provider Directory
Tax ID family
Cobb County Community Services Board13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

NPI Registry JSON

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

{
    "created_epoch": "1358208000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1358208000000",
    "number": "1801133459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3830 S COBB DR SE",
            "address_2": "SUITE 300",
            "city": "SMYRNA",
            "state": "GA",
            "postal_code": "300805532",
            "telephone_number": "770-429-5020",
            "fax_number": "678-213-1450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "218 SOUTH AVE SE",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300602384",
            "telephone_number": "770-429-5020",
            "fax_number": "678-213-1450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COBB COMMUNITY SERVICES BOARD",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-15",
        "last_updated": "2013-01-15",
        "status": "A",
        "authorized_official_last_name": "CITRON",
        "authorized_official_first_name": "TOD",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "770-429-5000",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000599783Q",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Annette Carter Home",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Marietta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2013; 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.