Organization Name: | SOUTHWESTERN STATE HOSPITAL |
NPI Number: | 1851473912 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | HILARY J. HOO-YOU (REGIONAL HOSPITAL ADMINISTRATOR) |
Mailing Address: | 114 Cove Landing Dr Community Medicaid Waiver Home Rts Thomasville |
State: | GA US |
Postal Code: | 317923883 |
Phone Number: | 2292272977 |
Fax Number: | 2292272955 |
NPI Enumeration Date: | 10/19/2006 |
NPI Last Update Date: | 08/18/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 320900000X |
License Number: | 136-01-076-1 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Residential Treatment Facilities |
Taxonomy Classification: | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
Taxonomy Specialization: | |
Taxonomy Definition: | A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. |