Organization
CSB OF EAST CENTRAL GA
Active
Other names
HEINHOLD PCH
Organization subpart
No
Provider details
NPI number
Authorized official
WANDA JESSIE (BILLING MANAGER)
(706) 432-4858
Entity
Organization
Contact information
Practice address
1669 CAROLYN LAKE CIR, THOMSON, GA 30824-4523
(706) 432-4858
(706) 432-3780
Mailing address
3421 MIKE PADGETT HWY, AUGUSTA, GA 30906-3815
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000927693AB
—
GA
Enumeration date
01/21/2010
Last updated
01/21/2010
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