Provider Demographics
NPI:1134297328
Name:UNITED CEREBRAL PALSY OF GEORGIA INC.
Entity Type:Organization
Organization Name:UNITED CEREBRAL PALSY OF GEORGIA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILUSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-676-2000
Mailing Address - Street 1:3300 N.E. EXPRESSWAY
Mailing Address - Street 2:BLDG 9
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341
Mailing Address - Country:US
Mailing Address - Phone:770-676-2000
Mailing Address - Fax:770-455-8040
Practice Address - Street 1:3300 NORTHEAST EXPY NE
Practice Address - Street 2:BLDG 9
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-3932
Practice Address - Country:US
Practice Address - Phone:770-676-2000
Practice Address - Fax:770-455-8040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child