THE HOMEPLACE SHELTER INC. (NPI# 1346473246) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1346473246 |
| Entity Type | Organization |
| Organization Name | THE HOMEPLACE SHELTER INC. |
| Other Organization Name | MILDRED'S HOMEPLACE III |
| Practice Address |
612 E Clay St Thomasville GA 31792-4608 |
| Mailing Address |
612 E Clay St 610 East Clay Street Thomasville GA 31792-4608 |
| Practice Telephone | 2295510695 |
| Practice Fax Number | 2295510694 |
| Mailing Telephone | 2295510695 |
| Mailing Fax Number | 2295510694 |
| Enumeration Date | 2009-08-26 |
| Last Update Date | 2009-08-26 |
| Authorized Official Name | MR. NANCY LEE MITCHELL (ADMINISTRATOR) |
| Authorized Official Telephone | 2292281985 |
| Is Organization Subpart | Y |
| Parent Organization Name | THE HOMEPLACE SHELTER INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 251C00000X | Day Training, Developmentally Disabled Services | 136-01-096-1 | GA | Agencies |
| N | 347C00000X | Private Vehicle | 136-01-096-1 | GA | Transportation Services |
| Y | 320900000X | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 136-01-096-1 | GA | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | PERSONAL CARE HOME | 136-01-096-1 | 01 |
| Other Name | Type Code |
|---|---|
| Mildred's HomePlace III | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427013531 | The Homeplace Shelter Inc. | Counselor | 612 E Clay St, Thomasville, GA 31792-4608 | 2006-04-20 |
| Street Address |
612 E CLAY ST |
| City | THOMASVILLE |
| State | GA |
| Zip Code | 31792-4608 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427013531 | The Homeplace Shelter Inc. | Counselor | 612 E Clay St, Thomasville, GA 31792-4608 | 2006-04-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245739879 | Georgia Pines Community Service Board | Community/Behavioral Health | 407 Cloverdale Drive, Thomasville, GA 31792 | 2018-02-09 |
| 1932613551 | Diana Diaz | Physician Assistant | 2705 E Pinetree Blvd Ste A, Thomasville, GA 31792 | 2017-11-17 |
| 1194249425 | Bobbie Frazier | Contractor | 400 Cloverdale Dr, Thomasville, GA 31792 | 2017-07-28 |
| 1598132292 | Southern Scripts, LLC | Pharmacy | 501 Gordon Avenue, Thomasville, GA 31792 | 2015-08-28 |
| 1508248915 | Elizabeth Nicole Keen | Behavioral Analyst | 121 Covington Ave Apt 9, Thomasville, GA 31792 | 2015-06-22 |
| 1417341579 | Sheila L Stanley | Counselor | 301 Summercreek Cove, Thomasville, GA 31792 | 2015-03-26 |
| 1457749301 | Ashley Lamb | Speech-Language Pathologist | 1203 East Jackson Street, Thomasville, GA 31792 | 2014-12-30 |
| 1831403880 | Somnoquest | Durable Medical Equipment & Medical Supplies | 556 Hall Road, Thomasville, GA 31792 | 2010-08-02 |
| 1508000183 | Kashyap B Choksi | Internal Medicine | 100 Mimosa Drive 2nd Floor, Thomasville, GA 31792 | 2009-04-27 |
| 1205008786 | Mark J Glaccum | Chiropractor | 415 Gordon Avenue, Thomasville, GA 31792 | 2008-03-25 |
| Find all providers in zip 31792 | ||||
| Taxonomy Code | 320900000X |
| Grouping | Residential Treatment Facilities |
| Classification | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
| A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003049057 | Department of Behavioral Health & Developmental Disabilities | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 213 Martin Luke King Drive, Community Medicaid Waiver Home, Thomasville, GA 31792-6320 | 2009-08-25 |
| 1922235050 | Department of Behavioral Health & Dev. Disabilities | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 309b Shoreline Dr, Community Medicaid Comp Waiver Home, Thomasville, GA 31757-2577 | 2009-06-16 |
| 1548407364 | Southwestern State Hospital | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 419 N Crawford St, Community Medicaid Comp Waiver Home, Thomasville, GA 31792-5128 | 2009-01-15 |
| 1326285248 | Southwestern State Hospital | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 845 Crabapple Dr, Community Medicaid Comp Homes, Thomasville, GA 31757-1400 | 2009-01-14 |
| 1497992457 | Southwestern State Hospital | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 309a Shoreline Dr, Community Medicaid Comp Waiver Home, Thomasville, GA 31757-2577 | 2009-01-13 |
| 1871675934 | Southwestern State Hospital | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 8 Belmont Dr, Community Medicaid Waiver Home Chss, Thomasville, GA 31792-4725 | 2006-10-19 |
| 1851473912 | Southwestern State Hospital | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 114 Cove Landing Dr, Community Medicaid Waiver Home Rts, Thomasville, GA 31792-3883 | 2006-10-19 |
| 1881776946 | Southwestern State Hospital | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 130 Cove Landing Dr, Community Medicaid Waiver Home Mrwp, Thomasville, GA 31792-3883 | 2006-10-19 |
| 1770665838 | Department of Behavioral Health & Developmental Disabilities | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 213 N Martin Luther King Jr Dr, Community Medicaid Waiver Home, Thomasville, GA 31792-6320 | 2006-10-19 |
| 1891788097 | Southwestern State Hospital | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 113 Cove Landing Dr, Community Medicaid Waiver Home, Thomasville, GA 31792-3884 | 2005-08-24 |
| Find all providers in THOMASVILLE | ||||
| City | THOMASVILLE |
| Zip Code | 31792 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.