BHG XLV, LLC (NPI# 1992241400) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1992241400 |
| Entity Type | Organization |
| Organization Name | BHG XLV, LLC |
| Practice Address |
2402 Tift Ave N Suite 202 Tifton GA 31794-1883 |
| Mailing Address |
5001 Spring Valley Rd Suite 600 East Dallas TX 75244-3946 |
| Practice Telephone | 7579620748 |
| Mailing Telephone | 2143656100 |
| Mailing Fax Number | 2143656150 |
| Enumeration Date | 2017-01-09 |
| Last Update Date | 2019-02-20 |
| Authorized Official Name | JEMECE MICHELLE GASAWAY (DIRECTOR OF LICENSING) |
| Authorized Official Telephone | 2143656126 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
NTP001047 | GA | Ambulatory Health Care Facilities |
| N | 261QM2800X |
Clinic/Center Specialization: Methadone Clinic |
NTP001047 | GA | Ambulatory Health Care Facilities |
| Y | 261QR0405X |
Clinic/Center Specialization: Rehabilitation, Substance Use Disorder |
NTP001047 | GA | Ambulatory Health Care Facilities |
| Street Address |
2402 TIFT AVE N SUITE 202 |
| City | TIFTON |
| State | GA |
| Zip Code | 31794-1883 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285678359 | Susan Riddle Gordon | Social Worker | 2402 Tift Ave N, Suite 102, Tifton, GA 31794-1883 | 2006-06-16 |
| 1598269334 | Travis Clark Hall | Counselor | 2402 Tift Ave N, Tifton, GA 31794-1883 | 2018-03-19 |
| 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 | 261QR0405X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rehabilitation, Substance Use Disorder |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497217715 | Peachtree Recovery Centers, LLC | Clinic/Center | 3975 Roswell Rd Ne Ste 104, Atlanta, GA 30342-4119 | 2019-04-04 |
| 1902374812 | Centered Recovery Programs, LLC | Clinic/Center | 1000 Piedmont Rd, Marietta, GA 30066-4032 | 2018-11-08 |
| 1255816302 | Brainscience Recovery.works | Clinic/Center | 4233 Pleasant Hill Rd Ste 110, Duluth, GA 30096-1609 | 2018-09-25 |
| 1619469665 | First Georgia Counseling Services LLC | Clinic/Center | 921 W Taylor St, Griffin, GA 30223-2605 | 2018-06-05 |
| 1952899775 | Manifest Recovery | Clinic/Center | 1215 Hightower Trl Ste 201, Sandy Springs, GA 30350-6244 | 2018-04-26 |
| 1003317538 | East Point Recovery Center | Clinic/Center | 100 Governors Trce Ste 110, Peachtree City, GA 30269-4853 | 2018-02-21 |
| 1538671011 | Summit Wellness Group, Inc | Clinic/Center | 745 Hembree Pl, Roswell, GA 30076-4035 | 2017-10-24 |
| 1891214375 | Centered Recovery Programs, LLC | Clinic/Center | 1250 Upper Hembree Rd Ste E, Roswell, GA 30076-4651 | 2017-09-15 |
| 1386009520 | Georgia Detox and Recovery, LLC | Clinic/Center | 2812 Hillcreek Dr Ste B, Augusta, GA 30909-5632 | 2015-12-15 |
| 1427424183 | Trek Medical, LLC | Clinic/Center | 5895 Windward Parkway, Suite 150, Alpharetta, GA 30005 | 2015-08-18 |
| 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.