Organization
SOUTHWESTERN STATE HOSPITAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. HILARY J. HOO-YOU (REGIONAL HOSPITAL ADMINISTRATOR)
(229) 227-3021
Entity
Organization
Contact information
Practice address
113 COVE LANDING DR, COMMUNITY MEDICAID WAIVER HOME RTS, THOMASVILLE, GA 31792-3884
(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
—
304774584B
—
GA
Enumeration date
10/19/2006
Last updated
08/18/2009
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