Provider Demographics
NPI:1518201375
Name:MIDDLE FLINT AREA COMMUNITY SERVICE BOARD
Entity Type:Organization
Organization Name:MIDDLE FLINT AREA COMMUNITY SERVICE BOARD
Other - Org Name:MIDDLE FLINT BEHAVIORAL HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:RAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-931-2470
Mailing Address - Street 1:PO BOX 1348
Mailing Address - Street 2:415 N JACKSON ST.
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-1348
Mailing Address - Country:US
Mailing Address - Phone:229-931-2470
Mailing Address - Fax:
Practice Address - Street 1:1524 S LEE ST
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-4413
Practice Address - Country:US
Practice Address - Phone:229-931-2829
Practice Address - Fax:229-931-2474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003128168AMedicaid