Provider Demographics
NPI:1083070718
Name:ROOSEVELT'S CHARACTER DEVELOPMENT CENTER
Entity Type:Organization
Organization Name:ROOSEVELT'S CHARACTER DEVELOPMENT CENTER
Other - Org Name:RCDC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROOSEVELT
Authorized Official - Middle Name:
Authorized Official - Last Name:CONE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:912-541-2809
Mailing Address - Street 1:119 S COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-5202
Mailing Address - Country:US
Mailing Address - Phone:912-541-2809
Mailing Address - Fax:
Practice Address - Street 1:119 S COLLEGE ST
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-5202
Practice Address - Country:US
Practice Address - Phone:912-541-2809
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-11
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty