DEKALB COMMUNITY SERVICE BOARD (NPI# 1629113436) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629113436 |
| Entity Type | Organization |
| Organization Name | DEKALB COMMUNITY SERVICE BOARD |
| Other Organization Name | TUCKER GROUP HOME |
| Practice Address |
4559 Lavista Rd Tucker GA 30084-4225 |
| Mailing Address |
455 Winn Way Fl 4 Decatur GA 30030-1707 |
| Practice Telephone | 7702708994 |
| Practice Fax Number | 7702708994 |
| Mailing Telephone | 4042943836 |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2020-04-22 |
| Authorized Official Name | FABIO BRUNO VAN DER MERWE (COO) |
| Authorized Official Telephone | 4042943836 |
| Is Organization Subpart | Y |
| Parent Organization Name | DEKALB COMMUNITY SERVICE BOARD |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 251S00000X | Community/Behavioral Health | Agencies |
| Other Name | Type Code |
|---|---|
| Tucker Group Home | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750426755 | Dekalb Community Service Board | Community/Behavioral Health | 2129 Luray Ct, Dunwoody, GA 30338-5212 | 2007-02-20 |
| 1548304637 | Dekalb Community Service Board | Community/Behavioral Health | 4781 Lewis Rd, Stone Mountain, GA 30083-1020 | 2007-02-20 |
| 1932244993 | Dekalb Community Service Board | Community/Behavioral Health | 1116 Alford Rd, Lithonia, GA 30058-6094 | 2007-02-20 |
| 1154466142 | Dekalb Community Service Board | Community/Behavioral Health | 3571 Embry Cir, Chamblee, GA 30341-5613 | 2007-02-20 |
| 1497890214 | Dekalb Community Service Board | Community/Behavioral Health | 4200 Waterloo Cir, Tucker, GA 30084-2237 | 2007-02-20 |
| 1861536955 | Dekalb Community Service Board | Community/Behavioral Health | 2660 Osborne Rd Ne, Atlanta, GA 30319-2832 | 2007-02-20 |
| 1003951088 | Dekalb Community Service Board | Community/Behavioral Health | 4316 Smithsonia Dr, Tucker, GA 30084-2615 | 2007-02-20 |
| 1427193226 | Dekalb Community Service Board | Community/Behavioral Health | 1536 Saint Dunstans Rd, Lithonia, GA 30058-5632 | 2007-02-20 |
| 1528103512 | Dekalb Community Service Board | Community/Behavioral Health | 3807 Clairmont Road Ne, Chamblee, GA 30341 | 2007-02-20 |
| 1740324805 | Dekalb Community Service Board | Community/Behavioral Health | 3100 Clifton Springs Rd, Decatur, GA 30034-4606 | 2007-02-20 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | DEKALB COMMUNITY SERVICE BOARD | 445 Winn Way, Decatur, GA 30030-1707 |
| Street Address |
4559 LAVISTA RD |
| City | TUCKER |
| State | GA |
| Zip Code | 30084-4225 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609401355 | Excellent Medical Transport | Ambulance | 4378 Sentry Dr, Tucker, GA 30084 | 2020-03-03 |
| 1811468796 | Caleb Lee Ebbets | Physical Therapist | 1459 Montreal Road, Medical Office Building, Suite 301, Tucker, GA 30084 | 2018-12-17 |
| 1417436130 | Benjamin Han Wook Chong | Physical Therapist | 1460 Montreal Road East, Suite 300, Tucker, GA 30084 | 2018-08-13 |
| 1336659325 | Lavista Acupuncture and Herbal Medicine | Acupuncturist | 4915 Lavista Rd, Tucker, GA 30084 | 2017-10-04 |
| 1699294207 | Debrica Butler | Counselor | 1021 Oak Chase Dr., Apt C, Tucker, GA 30084 | 2017-09-14 |
| 1295264695 | Jolanta Wazgowska Hopkins | Social Worker | 4404 Idlewood Lane, Tucker, GA 30084 | 2017-06-08 |
| 1164956157 | Sage Dental Group of Georgia LLC | Dentist | 4320 Lavista Rd, Suite C119, Tucker, GA 30084 | 2017-04-17 |
| 1689107807 | Mashail Manzur | Podiatrist | 1460 Montreal Rd E, Ste 275, Tucker, GA 30084 | 2017-04-05 |
| 1053765578 | Jessica Spruyt | Speech-Language Pathologist | 3756 Lavista Rd Suite 104, Tucker, GA 30084 | 2016-04-21 |
| 1265802318 | Spine and Orthopedics of Atlanta, LLC | Clinic/Center | 1462 Montreal Rd Ste 218, Tucker, GA 30084 | 2015-10-01 |
| Find all providers in zip 30084 | ||||
| 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 |
|---|---|---|---|---|
| 1033640495 | Atlanta Premier Tutoring LLC | Community/Behavioral Health | 5966 Princeton Run Trl, Tucker, GA 30084-8461 | 2017-03-27 |
| 1932578572 | Revelations Counseling | Community/Behavioral Health | 6328 Wedgeview Dr, Tucker, GA 30084-8764 | 2015-09-23 |
| 1609272145 | Pathways To Life, Inc. | Community/Behavioral Health | 4228 1st Ave, Suite 5, Tucker, GA 30084-4426 | 2014-11-11 |
| 1497890214 | Dekalb Community Service Board | Community/Behavioral Health | 4200 Waterloo Cir, Tucker, GA 30084-2237 | 2007-02-20 |
| 1003951088 | Dekalb Community Service Board | Community/Behavioral Health | 4316 Smithsonia Dr, Tucker, GA 30084-2615 | 2007-02-20 |
| 1639416027 | Rice Counseling and Consulting Services, LLC | Community/Behavioral Health | 1479 Brockett Rd, Suite 102, Tucker, GA 30084-7326 | 2013-01-06 |
| 1508022096 | Trading Faces LLC | Community/Behavioral Health | 4500 Hugh Howell Rd, Suite 380, Tucker, GA 30084-4723 | 2008-08-04 |
| 1366576050 | Alliance for Change Through Treatment, LLC | Community/Behavioral Health | 3524 Habersham At Northlake, Bldg. A, Tucker, GA 30084-4009 | 2007-03-15 |
| 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.