Provider Demographics
NPI:1275678526
Name:FORENSIC COMMUNITY INTEGRATION HOME-ECRH
Entity Type:Organization
Organization Name:FORENSIC COMMUNITY INTEGRATION HOME-ECRH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERM REGIONAL HOSPITAL ADMINISTRA
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-790-2030
Mailing Address - Street 1:3405 MIKE PADGETT HWY
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30906-3815
Mailing Address - Country:US
Mailing Address - Phone:706-792-7021
Mailing Address - Fax:
Practice Address - Street 1:2720 MIKE PADGETT HWY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30906-3736
Practice Address - Country:US
Practice Address - Phone:706-792-7141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness