NPIMap

Organization Active NPI

Southwestern State Hospital

Doing business as Intensive Treatment Residence Program

  • Mental Illness Community Based Residential Treatment Facility
  • Thomasville, GA
National Provider Identifier
1912009341
Registry record updated Aug 18, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
License
581130678 Issued in GA
Legal business name
SOUTHWESTERN STATE HOSPITAL
Doing business as
Intensive Treatment Residence Program
Practice address
105 Bermuda Street
Patient Billing Dept.
Thomasville, GA 31792-4018
Phone
(229) 227-2997
Fax
(229) 227-2955
NPI assigned
Sep 5, 2006
Last updated
Aug 18, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2009

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

Authorized official

Name
Mrs. Hilary J Hoo-You
Title
Regional Hospital Administrator
Phone
(229) 227-3021

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X 581130678 GA Primary

Addresses

Primary practice location

105 Bermuda Street
Patient Billing Dept.
Thomasville, GA 31792-4018

Mailing address

P. O. Box 1378
Patient Billing Dept
Thomasville, GA 31792-4018
Phone (229) 227-2977

Other identifiers 1

IdentifierTypeStateIssuer
252378193BMedicaidGA

Other names 1

  • Intensive Treatment Residence Program Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Department of Behavioral Health Developmental Disabilities Ga53 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1157414400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1250553600000",
    "number": "1912009341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P. O. BOX 1378",
            "address_2": "PATIENT BILLING DEPT",
            "city": "THOMASVILLE",
            "state": "GA",
            "postal_code": "317924018",
            "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": "105 BERMUDA STREET",
            "address_2": "PATIENT BILLING DEPT.",
            "city": "THOMASVILLE",
            "state": "GA",
            "postal_code": "317924018",
            "telephone_number": "229-227-2997",
            "fax_number": "229-227-2955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWESTERN STATE HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-05",
        "last_updated": "2009-08-18",
        "status": "A",
        "authorized_official_last_name": "HOO-YOU",
        "authorized_official_first_name": "HILARY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "REGIONAL HOSPITAL ADMINISTRATOR",
        "authorized_official_telephone_number": "229-227-3021",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "GA",
            "license": "581130678",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "252378193B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Intensive Treatment Residence Program",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 18, 2009; 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.