NPIMap

Organization Active NPI

Second Nature Blue Ridge

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Clayton, GA
National Provider Identifier
1871706382
Registry record updated May 29, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
License
50017 Issued in GA
Legal business name
SECOND NATURE BLUE RIDGE
Practice address
236 File Street
Clayton, GA 30525-3023
Phone
(706) 212-2037
Fax
(706) 212-0354
NPI assigned
May 8, 2007
Last updated
May 29, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 29, 2012

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

Authorized official

Name
Angie Evans
Title
Business Office
Phone
(801) 766-6604

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X 50017 GA Primary

Addresses

Primary practice location

236 File Street
Clayton, GA 30525-3023

Mailing address

236 File Street
Clayton, GA 30525-3023
Phone (706) 212-2037

Other identifiers 1

IdentifierTypeStateIssuer
50017OtherGASTATE LICENSE NUMBER

National Provider Directory

National Provider Directory
Tax ID family
Dba Blue Ridge Therapeutic Wilderness2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

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": "1178582400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1338249600000",
    "number": "1871706382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "236 FILE STREET",
            "city": "CLAYTON",
            "state": "GA",
            "postal_code": "305253023",
            "telephone_number": "706-212-2037",
            "fax_number": "706-212-0354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "236 FILE STREET",
            "city": "CLAYTON",
            "state": "GA",
            "postal_code": "305253023",
            "telephone_number": "706-212-2037",
            "fax_number": "706-212-0354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SECOND NATURE BLUE RIDGE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-08",
        "last_updated": "2012-05-29",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "ANGIE",
        "authorized_official_title_or_position": "BUSINESS OFFICE",
        "authorized_official_telephone_number": "801-766-6604"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "GA",
            "license": "50017",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "50017",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clayton, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2012; 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.