Kiya Club Comprehensive Treatment Center

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

KIYA CLUB COMPREHENSIVE TREATMENT CENTER

Practice address

1258 Highway 138 SW
Riverdale, GA 30296-1402

Phone

(770) 994-2225

Fax

(770) 994-2226

NPI assigned

Dec 18, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Angela D Cosby, PH.D.

Title

Ceo/Owner

Phone

(770) 994-2225

Specialties & licenses 1

Addresses

Other names 1

• Kiya Club CTC Doing business as

Locations

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

{
    "created_epoch": "1197936000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1197936000000",
    "number": "1982888640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1258 HIGHWAY 138 SW",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "302961402",
            "telephone_number": "770-994-2225",
            "fax_number": "770-994-2226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1258 HIGHWAY 138 SW",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "302961402",
            "telephone_number": "770-994-2225",
            "fax_number": "770-994-2226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIYA CLUB COMPREHENSIVE TREATMENT CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-18",
        "last_updated": "2007-12-18",
        "status": "A",
        "authorized_official_last_name": "COSBY",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CEO/OWNER",
        "authorized_official_telephone_number": "770-994-2225",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kiya Club CTC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Behavioral Health Agency in Riverdale, GA
• Providers in Riverdale, GA by specialty
• Community/Behavioral Health Agency in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2007; 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.