# DEPARTMENT OF BEHAVIORAL HEALTH AND DEVELOPMENTAL DISABILITIES

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- **Entity:** Organization
- **Status:** Active
- **Other names:** East Central Regional Hospital
- **Organization subpart:** No

## Provider details

- **NPI number:** 1992036909
- **Authorized official:** MR. PAUL BROCK (REGIONAL HOSPITAL ADMINISTRATOR)
- **Authorized official phone:** (706) 790-2030

## Contact information

- **Practice address:** 100 MYRTLE BLVD, GRACEWOOD, GA 30812-1500
- **Practice address phone:** (706) 790-2496
- **Practice address fax:** (706) 790-2340
- **Mailing address:** 100 MYRTLE BLVD, GRACEWOOD, GA 30812-1500
- **Mailing address phone:** (706) 790-2030
- **Mailing address fax:** (706) 790-2025

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | PHH004147 | GA | Yes |

## Other

- **Enumeration date:** 01/15/2010
- **Last updated:** 05/20/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 000355737A | — | GA |
| 01 | — | 1110395 | NCPDP | GA |