NPIMap

Organization Active NPI

Fiesta Health LLC

  • Behavior Analyst
  • Savannah, GA
National Provider Identifier
1831827724
Registry record updated Sep 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
Legal business name
FIESTA HEALTH LLC
Practice address
800 E 70TH St
Savannah, GA 31405-4813
Phone
(912) 214-3314
Fax
(912) 722-4061
NPI assigned
Aug 10, 2022
Last updated
Sep 20, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2024

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

Authorized official

Name
Dr. Jordan P Boudreau, PHDNPI 1043567290
Title
Owner/Chief Clinical Officer
Phone
(231) 497-0555

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior AnalystGroup: 193400000X SINGLE SPECIALTY GROUP 103K00000X Primary

Addresses

Primary practice location

800 E 70TH St
Savannah, GA 31405-4813

Mailing address

634 Holgate Ave
Defiance, OH 43512-2038
Phone (912) 491-2491

National Provider Directory

National Provider Directory

Locations

1130 Northchase Pkwy SE
Ste 150
Marietta, GA 30067

Practitioners & affiliated clinicians

Practitioners 8

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": "1660089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726790400000",
    "number": "1831827724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "634 HOLGATE AVE",
            "city": "DEFIANCE",
            "state": "OH",
            "postal_code": "435122038",
            "telephone_number": "912-491-2491",
            "fax_number": "470-329-0008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 E 70TH ST",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314054813",
            "telephone_number": "912-214-3314",
            "fax_number": "912-722-4061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIESTA HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-10",
        "last_updated": "2024-09-20",
        "certification_date": "2024-09-20",
        "status": "A",
        "authorized_official_last_name": "BOUDREAU",
        "authorized_official_first_name": "JORDAN",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "OWNER/CHIEF CLINICAL OFFICER",
        "authorized_official_telephone_number": "231-497-0555",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Savannah, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2024; 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.