Organization
DEPARTMENT OF BEHAVIORAL HEALTH & DEVELOPMENTAL DISABILITIES
Active
Other names
Southwestern State Hospital
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. HILARY J HOO-YOU (REGIONAL HOSPITAL ADMINISTRATOR)
(229) 227-3020
Entity
Organization
Contact information
Practice address
213 MARTIN LUKE KING DRIVE, COMMUNITY MEDICAID WAIVER HOME, THOMASVILLE, GA 31792-6320
(229) 227-2977
(229) 227-2955
Mailing address
PO BOX 1378, PATIENT BILLING DEPT, THOMASVILLE, GA 31799-1378
(229) 227-2977
(229) 227-2955
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
136-01-076-1
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
304774584D
—
GA
Enumeration date
08/25/2009
Last updated
08/25/2009
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