NPIMap

Organization Active NPI

Georgia Dept of Human Resources

Doing business as Pecan Manor III

  • Intellectual Disabilities Intermediate Care Facility
  • Milledgeville, GA
National Provider Identifier
1871606178
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
Legal business name
GEORGIA DEPT OF HUMAN RESOURCES
Doing business as
Pecan Manor III
Practice address
451 Boland Cir
Milledgeville, GA 31062-7525
Phone
(478) 445-4128
NPI assigned
Aug 17, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Marvin Bailey
Title
Regional Hospital Administrator
Phone
(478) 445-4128

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X Primary

Addresses

Primary practice location

451 Boland Cir
Milledgeville, GA 31062-7525

Mailing address

451 Boland Cir
Milledgeville, GA 31062-7525
Phone (478) 445-4128

Other identifiers 1

IdentifierTypeStateIssuer
00142403AMedicaidGA

Other names 1

  • Pecan Manor III Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Ga Department of Behavioral Health and Developmental Disabilities74 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 19

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

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1155772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1871606178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "451 BOLAND CIR",
            "city": "MILLEDGEVILLE",
            "state": "GA",
            "postal_code": "310627525",
            "telephone_number": "478-445-4128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "451 BOLAND CIR",
            "city": "MILLEDGEVILLE",
            "state": "GA",
            "postal_code": "310627525",
            "telephone_number": "478-445-4128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGIA DEPT OF HUMAN RESOURCES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BAILEY",
        "authorized_official_first_name": "MARVIN",
        "authorized_official_title_or_position": "REGIONAL HOSPITAL ADMINISTRATOR",
        "authorized_official_telephone_number": "478-445-4128",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00142403A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pecan Manor III",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Milledgeville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.