Provider Demographics
NPI:1326230020
Name:THE POTTER'S HOUSE FAMILY AND CHILDREN TREATMENT CENTER
Entity Type:Organization
Organization Name:THE POTTER'S HOUSE FAMILY AND CHILDREN TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, SECRETARY, TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:ELLIOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-247-5971
Mailing Address - Street 1:242 S. WASHINGTON BLVD.
Mailing Address - Street 2:PMB#177
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-6943
Mailing Address - Country:US
Mailing Address - Phone:678-330-1400
Mailing Address - Fax:678-330-1405
Practice Address - Street 1:2300 W. PARK PLACE BLVD.
Practice Address - Street 2:STE. 128, 135, 138
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-3561
Practice Address - Country:US
Practice Address - Phone:678-330-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-16
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)