NPIMap

Organization Active NPI

Southwestern State Hospital

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Thomasville, GA
National Provider Identifier
1891788097
Registry record updated Aug 22, 2020
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
SOUTHWESTERN STATE HOSPITAL
Practice address
113 Cove Landing Dr
Community Medicaid Waiver Home
Thomasville, GA 31792-3884
Phone
(229) 227-2977
Fax
(229) 227-2955
NPI assigned
Aug 24, 2005
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
Mrs. Beverly B. Bajerski
Title
Regional Hospital Administrator
Phone
(229) 227-3021

Specialties & licenses 1

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

Addresses

Primary practice location

113 Cove Landing Dr
Community Medicaid Waiver Home
Thomasville, GA 31792-3884

Mailing address

PO Box 1378
Patient Billing Dept
Thomasville, GA 31799-1378
Phone (229) 227-2977

Other identifiers 1

IdentifierTypeStateIssuer
00887236AMedicaidGA

National Provider Directory

National Provider Directory
Tax ID family
Roosevelt Warm SGP Inst74 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 18

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

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1124841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1891788097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1378",
            "address_2": "PATIENT BILLING DEPT",
            "city": "THOMASVILLE",
            "state": "GA",
            "postal_code": "317991378",
            "telephone_number": "229-227-2977",
            "fax_number": "229-227-2955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 COVE LANDING DR",
            "address_2": "COMMUNITY MEDICAID WAIVER HOME",
            "city": "THOMASVILLE",
            "state": "GA",
            "postal_code": "317923884",
            "telephone_number": "229-227-2977",
            "fax_number": "229-227-2955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWESTERN STATE HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-24",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BAJERSKI",
        "authorized_official_first_name": "BEVERLY",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "REGIONAL HOSPITAL ADMINISTRATOR",
        "authorized_official_telephone_number": "229-227-3021",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00887236A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Thomasville, 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.