Organization · Type 2 NPI

Department of Behavioral Health & Developmental Disabilities

Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Thomasville, GA

NPI number 1003049057 Active

Practice location

213 Martin Luke King Drive, Community Medicaid Waiver Home
Thomasville, GA 31792-6320

Call (229) 227-2977 Map

Fax (229) 227-2955

Mailing address

PO Box 1378, Patient Billing Dept
Thomasville, GA 31799-1378

Specialties and licenses

TaxonomyCodeLicense
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility Primary 320900000X136-01-076-1 (GA)

Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility: A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with intellectual and/or developmental disabilities.

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About NPI 1003049057

Department of Behavioral Health & Developmental Disabilities's National Provider Identifier is 1003049057, issued on Aug 25, 2009. The primary taxonomy on file is Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility (320900000X), and the practice location is in Thomasville, GA. The record was last updated on Aug 25, 2009.