CSB OF EAST CENTRAL GA (NPI# 1679804215) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1679804215 |
Entity Type | Organization |
Organization Name | CSB OF EAST CENTRAL GA |
Other Organization Name | WALTON MANOR PCH |
Practice Address |
2208 Walden Dr Augusta GA 30904-6508 |
Mailing Address |
3421 Mike Padgett Hwy Augusta GA 30906-3815 |
Practice Telephone | 7064324858 |
Practice Fax Number | 7064323780 |
Mailing Telephone | 7064324858 |
Mailing Fax Number | 7064323780 |
Enumeration Date | 2010-01-21 |
Last Update Date | 2010-01-21 |
Authorized Official Name | WANDA JESSIE (BILLING MANAGER) |
Authorized Official Telephone | 7064324858 |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 320600000X | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | Residential Treatment Facilities |
State | Issuer | Identifier | Type Code |
---|---|---|---|
GA | 000605833K | 05 |
Other Name | Type Code |
---|---|
WALTON MANOR PCH | Doing Business As Name - Organization |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1467013821 | Csb of East Central Ga | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 5101 Parnell Way, Martinez, GA 30907-8896 | 2019-06-26 |
1811436512 | Csb of East Central Ga | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 4008 Ramswood Dr, Hephzibah, GA 30815-5849 | 2017-02-15 |
1508305285 | Csb of East Central Ga | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 3126 Richmond Hill Rd, Augusta, GA 30906-4754 | 2017-02-15 |
1447798707 | Csb of East Central Ga | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 355 Bobwhite Trl, Grovetown, GA 30813-5886 | 2017-02-07 |
1346565926 | Csb of East Central Ga | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 3015 Manchester Dr, Hephzibah, GA 30815-7166 | 2010-04-07 |
1700101391 | Csb of East Central Ga | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 2006 Country Place Dr, Augusta, GA 30906-8732 | 2010-04-07 |
1588995112 | Csb of East Central Ga | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 386 Tower Rd, Augusta, GA 30907-8750 | 2010-01-21 |
1881925410 | Csb of East Central Ga | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 3461 Camak Dr, Augusta, GA 30909-9433 | 2010-01-21 |
1053642686 | Csb of East Central Ga | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 2115 Ashley Dr, Augusta, GA 30906-5085 | 2010-01-21 |
1790016327 | Csb of East Central Ga | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 2110 Stevens Rd, Augusta, GA 30906-2058 | 2010-01-21 |
Street Address |
2208 WALDEN DR |
City | AUGUSTA |
State | GA |
Zip Code | 30904-6508 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1518423706 | Lawren Murray Tachias | Registered Nurse | 950 15th Street Downtown, Augusta, GA 30904 | 2019-02-13 |
1457851842 | Heba Ahmed | Pharmacist | 912 15th Street, Augusta, GA 30904 | 2018-02-13 |
1124552690 | Jenny Liles | Student in an Organized Health Care Education/Training Program | 1004 Chafee Ave, Augusta, GA 30904 | 2017-04-11 |
1932640836 | Claudia Crawford | Student in an Organized Health Care Education/Training Program | 2624 Oakland Ave., Augusta, GA 30904 | 2017-03-13 |
1801240528 | F. Marion Durst IIi Dmd PC | Clinic/Center | 2325 Washington Road, Augusta, GA 30904 | 2016-04-19 |
1689031296 | Teresa Maria Martin | Counselor | 1e-148, Charlie Norwood Vamc One Freedom Way, Augusta, GA 30904 | 2016-01-27 |
1598122269 | Jillian Wilkerson | Counselor | Charlie Norwood Veteran Affairs One Freedom Way, Substance Use Recovery Clinic, Augusta, GA 30904 | 2016-01-26 |
1760855241 | Chase King | Occupational Therapist | 1735 Berkeley Rd, Augusta, GA 30904 | 2015-11-05 |
1962832246 | April Underwood Fox | Physician Assistant | 1417 Pendleton Rd, Augusta, GA 30904 | 2013-11-22 |
1861734378 | John Graham Theisen | Obstetrics & Gynecology | 810 Chafee Avenue, Augusta, GA 30904 | 2013-03-22 |
Find all providers in zip 30904 |
Taxonomy Code | 320600000X |
Grouping | Residential Treatment Facilities |
Classification | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently. |
Notes: [7/1/2003: new] |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1942691431 | Vincent Roselli | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 2416 Eagle Dr, Augusta, GA 30906-3325 | 2015-02-05 |
1861735391 | Beverly Briggs | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 3520 Primrose Ct, Augusta, GA 30906-9576 | 2013-04-03 |
1821392572 | Renee's Personal Care Home, LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1916 Ohio Ave, Augusta, GA 30904-5329 | 2011-01-10 |
1700101391 | Csb of East Central Ga | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 2006 Country Place Dr, Augusta, GA 30906-8732 | 2010-04-07 |
1588995112 | Csb of East Central Ga | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 386 Tower Rd, Augusta, GA 30907-8750 | 2010-01-21 |
1881925410 | Csb of East Central Ga | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 3461 Camak Dr, Augusta, GA 30909-9433 | 2010-01-21 |
1053642686 | Csb of East Central Ga | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 2115 Ashley Dr, Augusta, GA 30906-5085 | 2010-01-21 |
1790016327 | Csb of East Central Ga | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 2110 Stevens Rd, Augusta, GA 30906-2058 | 2010-01-21 |
1437480035 | Csb of East Central Ga | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 313 S Belair Rd, Augusta, GA 30907-8835 | 2010-01-21 |
1366773905 | Csb of East Central Ga | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 4027 Wheeler Rd, Augusta, GA 30901 | 2010-01-21 |
Find all providers in AUGUSTA |
Please comment or provide details below to improve the information on CSB OF EAST CENTRAL GA.
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.