Provider Demographics
NPI:1558612374
Name:CARE WIND PLACE, INC
Entity Type:Organization
Organization Name:CARE WIND PLACE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:LYNETTE
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:478-390-1172
Mailing Address - Street 1:2895 JORDAN AVE
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31217-4919
Mailing Address - Country:US
Mailing Address - Phone:478-390-1172
Mailing Address - Fax:478-330-6692
Practice Address - Street 1:2895 JORDAN AVE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217-4919
Practice Address - Country:US
Practice Address - Phone:478-390-1172
Practice Address - Fax:478-330-6692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-20
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACLA 000754385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA583023880AMedicaid