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Dekalb Community Service Board

Organization Active NPI Community/Behavioral Health Agency · Lithonia, GA

NPI 1932244993 · NPPES record last updated Apr 23, 2020

Key facts

NPI
1932244993
Entity type
Organization (NPI type 2)
Primary specialty
Community/Behavioral Health Agency 251S00000X
Legal business name
DEKALB COMMUNITY SERVICE BOARD
Practice address
1116 Alford Rd
Lithonia, GA 30058-6094
Phone
(770) 484-9582
Fax
(770) 484-9582
NPI assigned
Feb 20, 2007
Organization subpart
Yes
Parent organization (as reported)
DEKALB COMMUNITY SERVICE BOARD

Authorized official

Name
Fabio Bruno Van Der Merwe
Title
Coo
Phone
(404) 294-3836

Corporate family (same tax ID) 23

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

National Provider Directory

Tax ID family
Dekalb Community Serv (24 organizations share this tax ID)
Part of
Dekalb Community Serv

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Yes

Addresses

Primary practice location

1116 Alford Rd
Lithonia, GA 30058-6094

Mailing address

445 Winn Way FL 4
Decatur, GA 30030-1707
Phone (404) 294-3836

Other names

  • Alford Road Group Home Other name

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Apr 23, 2020.

{
    "created_epoch": "1171929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1587600000000",
    "number": "1932244993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "445 WINN WAY FL 4",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300301707",
            "telephone_number": "404-294-3836"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1116 ALFORD RD",
            "city": "LITHONIA",
            "state": "GA",
            "postal_code": "300586094",
            "telephone_number": "770-484-9582",
            "fax_number": "770-484-9582"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEKALB COMMUNITY SERVICE BOARD",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DEKALB COMMUNITY SERVICE BOARD",
        "enumeration_date": "2007-02-20",
        "last_updated": "2020-04-23",
        "certification_date": "2020-04-23",
        "status": "A",
        "authorized_official_last_name": "VAN DER MERWE",
        "authorized_official_first_name": "FABIO",
        "authorized_official_middle_name": "BRUNO",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "404-294-3836"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Alford Road Group Home",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Lithonia, GA

All providers in Lithonia, GA · Community/Behavioral Health Agency in Georgia

Sources for this page

Verify at the official NPI Registry.