Provider Demographics
NPI:1457637399
Name:THE COTTAGES ON MOUNTAIN CREEK, LLC
Entity Type:Organization
Organization Name:THE COTTAGES ON MOUNTAIN CREEK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:MAI, CCIM
Authorized Official - Phone:404-786-4440
Mailing Address - Street 1:5800 MOUNTAIN CREEK RD NE
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5035
Mailing Address - Country:US
Mailing Address - Phone:404-228-6554
Mailing Address - Fax:404-963-0555
Practice Address - Street 1:5815 MOUNTAIN CREEK RD NE
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-5036
Practice Address - Country:US
Practice Address - Phone:404-228-6445
Practice Address - Fax:404-963-0555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPCH006602104100000X, 320800000X, 323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAHCO520306OtherJOINT COMMISSION HEALTH CARE