NPIMap

Organization Active NPI

Macklander, LLC

Doing business as Macksimum Alliance

  • Developmental Disabilities Clinic/Center
  • Grovetown, GA
National Provider Identifier
1801134739
Registry record updated Jan 28, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmental Disabilities Clinic/CenterTaxonomy code 261QD1600X
License
036-R-0525 Issued in GA
Legal business name
MACKLANDER, LLC
Doing business as
Macksimum Alliance
Practice address
1514 Baldwin Lakes Dr
Grovetown, GA 30813-5887
Phone
(706) 854-0555
Fax
(706) 651-9677
NPI assigned
Jan 28, 2013
Organization subpart
Yes
Parent organization
MACKLANDER, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 28, 2013

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

Authorized official

Name
Mrs. Shelley Diane MackNPI 1134435092
Title
Administrator
Phone
(706) 854-0555

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Care Agency 251J00000X 036-R-0525 GA
Developmental Disabilities Clinic/Center 261QD1600X 036-R-0525 GA Primary

Addresses

Primary practice location

1514 Baldwin Lakes Dr
Grovetown, GA 30813-5887

Mailing address

1514 Baldwin Lakes Dr
Grovetown, GA 30813-5887
Phone (706) 854-0555

Other identifiers 2

IdentifierTypeStateIssuer
366878280BMedicaidGA
366878280AMedicaidGA

Other names 1

  • Macksimum Alliance Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Lizzy's Adult Community Service Center2 organizations share this tax ID, including this one
Part of
Lizzy's Adult Community Service Center

Other organizations with this tax ID 1

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

Practitioners & affiliated clinicians

Practitioners 1

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": "1359331200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1359331200000",
    "number": "1801134739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1514 BALDWIN LAKES DR",
            "city": "GROVETOWN",
            "state": "GA",
            "postal_code": "308135887",
            "telephone_number": "706-854-0555",
            "fax_number": "706-651-9677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1514 BALDWIN LAKES DR",
            "city": "GROVETOWN",
            "state": "GA",
            "postal_code": "308135887",
            "telephone_number": "706-854-0555",
            "fax_number": "706-651-9677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MACKLANDER, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MACKLANDER, LLC",
        "enumeration_date": "2013-01-28",
        "last_updated": "2013-01-28",
        "status": "A",
        "authorized_official_last_name": "MACK",
        "authorized_official_first_name": "SHELLEY",
        "authorized_official_middle_name": "DIANE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "706-854-0555",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": "GA",
            "license": "036-R-0525",
            "primary": false
        },
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": "GA",
            "license": "036-R-0525",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "366878280B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "366878280A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Macksimum Alliance",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Grovetown, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 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.