Provider Demographics
NPI:1497047054
Name:BLECKLEY COUNTY MR SERVICE CENTER
Entity Type:Organization
Organization Name:BLECKLEY COUNTY MR SERVICE CENTER
Other - Org Name:BEHAVIORAL SOCIAL SERVICES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:REED
Authorized Official - Last Name:FLOYD
Authorized Official - Suffix:
Authorized Official - Credentials:C E O
Authorized Official - Phone:478-230-5627
Mailing Address - Street 1:133 LIMESTONE RD APT F43
Mailing Address - Street 2:
Mailing Address - City:COCHRAN
Mailing Address - State:GA
Mailing Address - Zip Code:31014-7042
Mailing Address - Country:US
Mailing Address - Phone:478-230-5627
Mailing Address - Fax:
Practice Address - Street 1:133 LIMESTONE RD
Practice Address - Street 2:
Practice Address - City:COCHRAN
Practice Address - State:GA
Practice Address - Zip Code:31014-7036
Practice Address - Country:US
Practice Address - Phone:478-230-5627
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-13
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services