Provider Demographics
NPI:1316003312
Name:WALTON COMMUNITY SERVICES, INC
Entity Type:Organization
Organization Name:WALTON COMMUNITY SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:WALTON
Authorized Official - Suffix:
Authorized Official - Credentials:RNBSN
Authorized Official - Phone:770-943-6858
Mailing Address - Street 1:561 THORNTON RD
Mailing Address - Street 2:SUITE Z
Mailing Address - City:LITHIA SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30122-1558
Mailing Address - Country:US
Mailing Address - Phone:770-943-6858
Mailing Address - Fax:770-943-2667
Practice Address - Street 1:561 THORNTON RD
Practice Address - Street 2:SUITE Z
Practice Address - City:LITHIA SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30122-1558
Practice Address - Country:US
Practice Address - Phone:770-943-6858
Practice Address - Fax:770-943-2667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000857315GMedicaid
GA000857315AMedicaid
GA000857315EMedicaid
GA000857315CMedicaid
GA000857315HMedicaid
GA330114019AMedicaid
GA000857315FMedicaid
GA000857315IMedicaid
GA000857315BMedicaid