# NW GA REGIONAL HOSPITAL ICF MR

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** STATE OF GEORGIA
- **Other names:** State of Georgia
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1437223914
- **Legal business name:** STATE OF GEORGIA
- **Authorized official:** TAMMY VAUGHN (PATIENT ACCOUNTS OFFICER)
- **Authorized official phone:** (706) 295-6298

## Contact information

- **Practice address:** 1305 REDMOND CIR NW, ROME, GA 30165-1345
- **Practice address phone:** (706) 295-6298
- **Practice address fax:** (706) 802-5400
- **Mailing address:** 1305 REDMOND CIR NW, ROME, GA 30165-1345
- **Mailing address phone:** (706) 295-6298
- **Mailing address fax:** (706) 802-5400

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 315P00000X | Intellectual Disabilities Intermediate Care Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 11/17/2006
- **Last updated:** 01/29/2008