Provider Demographics
NPI:1487185492
Name:DONNEL CROSS HOST HOME
Entity Type:Organization
Organization Name:DONNEL CROSS HOST HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:912-449-7100
Mailing Address - Street 1:408 MACKENZIE CIR
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31533-1319
Mailing Address - Country:US
Mailing Address - Phone:912-331-5816
Mailing Address - Fax:
Practice Address - Street 1:1007 MARY ST
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31503-3823
Practice Address - Country:US
Practice Address - Phone:912-449-7100
Practice Address - Fax:912-449-7063
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNISON BEHAVIORAL HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-22
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities