Provider Demographics
NPI:1093041121
Name:SYLVANUS MEMORIAL TREATMENT CENTERS, INC.
Entity Type:Organization
Organization Name:SYLVANUS MEMORIAL TREATMENT CENTERS, INC.
Other - Org Name:ROBERT W DAIL MEMORIAL TREATMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/SPONSOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:ROBINETTE
Authorized Official - Last Name:RATHBUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-335-5180
Mailing Address - Street 1:734 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:GA
Mailing Address - Zip Code:30529-1142
Mailing Address - Country:US
Mailing Address - Phone:706-335-5180
Mailing Address - Fax:706-335-5217
Practice Address - Street 1:734 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:GA
Practice Address - Zip Code:30529-1142
Practice Address - Country:US
Practice Address - Phone:706-335-5180
Practice Address - Fax:706-335-5217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-24
Last Update Date:2009-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GANTP001028261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone