Organization
SOUTHWESTERN STATE HOSPITAL
Active
Other names
Rose Haven ICF/MR
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
400 S PINETREE BLVD, THOMASVILLE, GA 31792-7128
(229) 227-3004
(227) 227-2663
Mailing address
PO BOX 1378, PATIENT BILLING DEPT, THOMASVILLE, GA 31799-1378
(229) 227-3004
(227) 227-2663
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
2-136-832
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00142799A
—
GA
Enumeration date
08/23/2005
Last updated
08/18/2009
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