SOUTHWESTERN STATE HOSPITAL (NPI# 1619045291) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619045291 |
| Entity Type | Organization |
| Organization Name | SOUTHWESTERN STATE HOSPITAL |
| Other Organization Name | ASSERTIVE COMMUNITY TREATMENT PROGRAM |
| Practice Address |
819 Tillman St Patient Billing Dept Hahira GA 31632-1451 |
| Mailing Address |
400 South Pinetree Blvd P.o. Box 1378 Patient Billing Dept Thomasville GA 31792-1378 |
| Practice Telephone | 2292272977 |
| Practice Fax Number | 2292272955 |
| Mailing Telephone | 2292272977 |
| Mailing Fax Number | 2292272955 |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2009-08-18 |
| Authorized Official Name | MR. HILARY J HOO-YOU (REGTIONAL HOSPITAL ADMINISTRATOR) |
| Authorized Official Telephone | 2292273020 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 251S00000X | Community/Behavioral Health | 581130678 | GA | Agencies |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 00877236G | 05 |
| Other Name | Type Code |
|---|---|
| Assertive Community Treatment Program | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 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 |
| 1841320280 | Southwestern State Hospital | Substance Abuse Rehabilitation Facility | 1500 Gillionville Rd Ste B, Albany, GA 31707-3963 | 2007-03-06 |
| 1366519811 | Southwestern State Hospital | Community/Behavioral Health | 200 W Oglethorpe Blvd Fl 4, Patient Billing Dept, Albany, GA 31701-6802 | 2006-11-29 |
| 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 |
| 1376645796 | Southwestern State Hospital | Community Based Residential Treatment Facility, Mental Illness | 307 Cloverdale Dr, Intensive Treatment Residence Program, Thomasville, GA 31792-4018 | 2006-09-05 |
| 1912009341 | Southwestern State Hospital | Community Based Residential Treatment Facility, Mental Illness | 105 Bermuda Street, Patient Billing Dept., Thomasville, GA 31792-4018 | 2006-09-05 |
| Street Address |
819 TILLMAN ST PATIENT BILLING DEPT |
| City | HAHIRA |
| State | GA |
| Zip Code | 31632-1451 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568912194 | Jennifer Washington | Counselor | 6675 Brookridge Drive, Hahira, GA 31632 | 2016-10-06 |
| 1730537044 | Kimberly Graham | Speech-Language Pathologist | 815 Kristen Lane, Hahira, GA 31632 | 2016-05-26 |
| 1740585934 | J.h. Harvey Co., LLC | Durable Medical Equipment & Medical Supplies | 775 Ga Hwy 122 W, Hahira, GA 31632 | 2011-01-19 |
| 1205990546 | South Health District | Public Health or Welfare | 503 W Main St, Hahira, GA 31632-1028 | 2006-12-21 |
| 1114420387 | Lindsey Baker Childress | Registered Nurse | 815 E Main St, Hahira, GA 31632-1058 | 2018-03-14 |
| 1154690337 | Henry Young Tillman IIi | Dentist | 950 Hwy 122 W, Hahira, GA 31632-1061 | 2011-12-18 |
| 1821007642 | Kit Harold Robinson | Dentist | 950 Ga Highway 122 W, Hahira, GA 31632-1061 | 2006-08-08 |
| 1972076396 | John Thomas Rust | Pharmacist | 775 Ga Highway 122 W, Hahira, GA 31632-1066 | 2019-01-08 |
| 1861039703 | Amanda Stankiewicz | Pharmacist | 775 Ga Highway 122 W, Hahira, GA 31632-1066 | 2019-12-10 |
| 1831513910 | Samson Merger Sub LLC | Durable Medical Equipment & Medical Supplies | 775 Ga Highway 122 W, Hahira, GA 31632-1066 | 2014-02-10 |
| Find all providers in zip 31632 | ||||
| Taxonomy Code | 251S00000X |
| Grouping | Agencies |
| Classification | Community/Behavioral Health |
| A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, mental retardation, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. |
| Notes: Source: National Medicaid EDI HIPAA NPI Sub Work Group [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801143474 | Ste Counseling Services, Inc. | Community/Behavioral Health | 5671 Boys Ranch Rd, Hahira, GA 31632-2582 | 2012-08-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699376160 | Love, Breanna Olivia Zion Enterprise,llc(lboz): | Community/Behavioral Health | 9802 N Ivy Park Dr, Fortson, GA 31808-7130 | 2020-11-02 |
| 1578170882 | Helping Hearts Behavioral Health Services, LLC | Community/Behavioral Health | 504 Hamlet Dr, Hampton, GA 30228-4829 | 2020-09-30 |
| 1982219523 | Future Seekers, Inc. | Community/Behavioral Health | 3475 N. Desert Drive, Building 1, Suite 2100, East Point, GA 30344-3034 | 2020-09-10 |
| 1396359840 | Just Like Family Caregivers | Community/Behavioral Health | 2628 Lovejoy Crossing St, Hampton, GA 30228-5995 | 2020-09-02 |
| 1285247270 | Hudu Yoga & Therapy | Community/Behavioral Health | 3900 Springleaf Ct, Stone Mountain, GA 30083-4692 | 2020-08-28 |
| 1952914632 | Brighter Dayz, Incorporated | Community/Behavioral Health | 1016 Howell Mill Rd Nw Apt 4408, Atlanta, GA 30318-5592 | 2020-08-24 |
| 1699387688 | Rise Rehabilitation Services, LLC | Community/Behavioral Health | 738 Highland Park Trl, Atlanta, GA 30350-6706 | 2020-08-20 |
| 1104438373 | Pivotal Counseling LLC | Community/Behavioral Health | 75 N Broad St, Winder, GA 30680-1907 | 2020-08-19 |
| 1295347888 | Freemans Early Intervention Services | Community/Behavioral Health | 13 Peach St, Butler, GA 31006 | 2020-08-17 |
| 1861017634 | Trinity Care Counseling | Community/Behavioral Health | 3475 Northwinds Parkway, 200, Alpharetta, GA 30009 | 2020-06-08 |
| Find all providers with the same taxonomy | ||||
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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.