# SOUTHWESTERN STATE HOSPITAL

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Rose Haven ICF/MR
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215920525
- **Authorized official:** MRS. HILARY J HOO-YOU (REGIONAL HOSPITAL ADMINISTRATOR)
- **Authorized official phone:** (229) 227-3020

## Contact information

- **Practice address:** 400 S PINETREE BLVD, THOMASVILLE, GA 31792-7128
- **Practice address phone:** (229) 227-3004
- **Practice address fax:** (227) 227-2663
- **Mailing address:** PO BOX 1378, PATIENT BILLING DEPT, THOMASVILLE, GA 31799-1378
- **Mailing address phone:** (229) 227-3004
- **Mailing address fax:** (227) 227-2663

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 315P00000X | Intellectual Disabilities Intermediate Care Facility | 2-136-832 | GA | Yes |

## Other

- **Enumeration date:** 08/23/2005
- **Last updated:** 08/18/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00142799A | — | GA |