Provider Demographics
NPI:1558501171
Name:CARTER'S GROUP HOME, INC
Entity Type:Organization
Organization Name:CARTER'S GROUP HOME, INC
Other - Org Name:CARTER'S GROUP HOME, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:RESIDENTIAL PROVIDER
Authorized Official - Phone:706-254-8113
Mailing Address - Street 1:297 SAWDUST TRL
Mailing Address - Street 2:
Mailing Address - City:NICHOLSON
Mailing Address - State:GA
Mailing Address - Zip Code:30565-5000
Mailing Address - Country:US
Mailing Address - Phone:706-757-3984
Mailing Address - Fax:
Practice Address - Street 1:91 RIGHTEOUS PATH
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:GA
Practice Address - Zip Code:30549-7037
Practice Address - Country:US
Practice Address - Phone:706-254-8113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-22
Last Update Date:2009-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA07801016320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities