SOUTHWESTERN STATE HOSPITAL (NPI# 1720156508) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720156508 |
| Entity Type | Organization |
| Organization Name | SOUTHWESTERN STATE HOSPITAL |
| Other Organization Name | ASSERTIVE COMMUNITY TREATMENT PROGRAM |
| Practice Address |
334 Tifton Eldorado Rd Tifton GA 31794-9497 |
| Mailing Address |
400 South Pinetree Blvd. P. O. Box 1378 Patient Billing Dept Thomasville GA 31799-1378 |
| 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 | MRS. HILARY J HOO-YOU (REGIONAL 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 | 00877236H | 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 |
| 1619045291 | Southwestern State Hospital | Community/Behavioral Health | 819 Tillman St, Patient Billing Dept, Hahira, GA 31632-1451 | 2006-12-01 |
| 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 |
| Street Address |
334 TIFTON ELDORADO RD |
| City | TIFTON |
| State | GA |
| Zip Code | 31794-9497 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558457655 | South Georgia Csb | Community/Behavioral Health | 334 Tifton Eldorado Rd, Tifton, GA 31794-9497 | 2006-10-05 |
| 1043844418 | Amanda L Cofield | Social Worker | 334 Tifton Eldorado Rd, Tifton, GA 31794-9497 | 2020-02-25 |
| 1124674767 | Robin Meadows | Social Worker | 334 Tifton Eldorado Rd, Tifton, GA 31794-9497 | 2019-08-09 |
| 1487219770 | Nyesia Knight | Counselor | 334 Tifton Eldorado Rd, Tifton, GA 31794-9497 | 2019-05-02 |
| 1275090086 | Daniel Jason Spratlin | Social Worker | 334 Tifton Eldorado Rd, Tifton, GA 31794-9497 | 2019-02-28 |
| 1487146932 | Norma Ann Chin | Counselor | 334 Tifton Eldorado Rd, Tifton, GA 31794-9497 | 2018-05-31 |
| 1235621897 | Jodi Evans Lott | Nurse Practitioner | 334 Tifton Eldorado Rd, Tifton, GA 31794-9497 | 2018-05-30 |
| 1760929228 | Tyundreya Lindsey | Marriage & Family Therapist | 334 Tifton Eldorado Rd, Tifton, GA 31794-9497 | 2017-01-23 |
| 1255875910 | Behavioral Health Services of South Georgia | Community/Behavioral Health | 334 Tifton Eldorado Rd, Tifton, GA 31794-9497 | 2016-12-14 |
| 1265976435 | Davina G Samuel | Counselor | 334 Tifton Eldorado Rd, Tifton, GA 31794-9497 | 2016-12-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982234043 | Deloris Lunsford | Licensed Practical Nurse | 903 Washington St., Tifton, GA 31794 | 2020-01-17 |
| 1194383075 | William Jordan Kinnett | Registered Nurse | 1205 Tift Ave N, Tifton, GA 31794 | 2019-06-05 |
| 1598321200 | Courtlyn Christanna Fussell | Pharmacist | 2201 Hwy 41 N, Tifton, GA 31794 | 2019-05-17 |
| 1376027722 | Martha Gibbs | Nurse Practitioner | Affinity Clinic/west Campus, 2225 Us Hwy 41 North, Tifton, GA 31794 | 2018-09-21 |
| 1427541044 | Rebekah F Cottle | Speech-Language Pathologist | 2227 Highway 41 North, Tifton, GA 31794 | 2018-06-08 |
| 1790280857 | Tift Regional Health System Inc | Ophthalmology | 1803 Old Ocilla Road, Tifton, GA 31794 | 2018-03-29 |
| 1568975431 | Skyler Clark | Pharmacist | 2201 North 12th Street, Tifton, GA 31794 | 2017-11-14 |
| 1538606306 | Imagine Peace Counseling LLC | Counselor | 223 E 2nd Street, Suite B, Tifton, GA 31794 | 2017-01-31 |
| 1073056347 | Jessica Tumbling | Contractor | 219 Savannah Way, Tifton, GA 31794 | 2016-11-18 |
| 1992159503 | Joseph Thomas Seagraves Jr. | Nurse Practitioner | 901 East 18th Street, Tifton, GA 31794 | 2016-04-20 |
| Find all providers in zip 31794 | ||||
| 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 |
|---|---|---|---|---|
| 1558457655 | South Georgia Csb | Community/Behavioral Health | 334 Tifton Eldorado Rd, Tifton, GA 31794-9497 | 2006-10-05 |
| 1407463177 | Give Kindness Wing | Community/Behavioral Health | 911 Main St S, Tifton, GA 31794-4867 | 2020-09-28 |
| 1255875910 | Behavioral Health Services of South Georgia | Community/Behavioral Health | 334 Tifton Eldorado Rd, Tifton, GA 31794-9497 | 2016-12-14 |
| 1609216027 | Georgia Pines Community Service Board | Community/Behavioral Health | 334 Tifton Eldorado Rd, Tifton, GA 31794-9497 | 2013-06-29 |
| 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 |
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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.