Provider Demographics
NPI:1255509972
Name:MIDDLE FLINT COMMUNITY SERVICE BOARD
Entity Type:Organization
Organization Name:MIDDLE FLINT COMMUNITY SERVICE BOARD
Other - Org Name:MIDDLE FLINT BEHAVIORAL HEALTHCARE
Other - Org Type:Other Name
Authorized Official - Title/Position:UTILIZATION MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-815-5286
Mailing Address - Street 1:415 N JACKSON ST
Mailing Address - Street 2:P.O. DRAWER 1348
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-3015
Mailing Address - Country:US
Mailing Address - Phone:229-931-2470
Mailing Address - Fax:229-931-2474
Practice Address - Street 1:100 HEADS AVE
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-3616
Practice Address - Country:US
Practice Address - Phone:229-931-2470
Practice Address - Fax:229-931-2474
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIDDLE FLINT AREA COMMUNITY SERVICE BOARD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-15
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000603237PMedicaid