Provider Demographics
NPI:1518964949
Name:DEPARTMENT OF HUMAN SERVICES
Entity Type:Organization
Organization Name:DEPARTMENT OF HUMAN SERVICES
Other - Org Name:ROOSEVELT WARM SPRINGS INSTITUTE FOR REHABILITATION , RETECH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BOATWRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-655-5598
Mailing Address - Street 1:PO BOX 1000
Mailing Address - Street 2:
Mailing Address - City:WARM SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:31830-1000
Mailing Address - Country:US
Mailing Address - Phone:706-655-5598
Mailing Address - Fax:706-655-5608
Practice Address - Street 1:6135 ROOSEVELT HWY
Practice Address - Street 2:
Practice Address - City:WARM SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:31830-2757
Practice Address - Country:US
Practice Address - Phone:706-655-5598
Practice Address - Fax:706-655-5608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
N/A332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA6710650001Medicare NSC
GA4279220001Medicare NSC