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Organization
DEPARTMENT OF BEHAVIORAL HEALTH AND DEVELOPMENTAL DISABILITIES
Active
Organization
DEPARTMENT OF BEHAVIORAL HEALTH AND DEVELOPMENTAL DISABILITIES
Active
Other names
East Central Regional Hospital
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PAUL BROCK (REGIONAL HOSPITAL ADMINISTRATOR)
(706) 790-2030
Entity
Organization
Contact information
Practice address
100 MYRTLE BLVD, GRACEWOOD, GA 30812-1500
(706) 790-2030
(706) 790-2025
Mailing address
100 MYRTLE BLVD, GRACEWOOD, GA 30812-1500
(706) 790-2030
(706) 790-2025
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
2-121-792
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000141204A
—
GA
Enumeration date
10/07/2009
Last updated
05/20/2015
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