Provider Demographics
NPI:1558632968
Name:AMERICANWORK, INC.
Entity Type:Organization
Organization Name:AMERICANWORK, INC.
Other - Org Name:AMERICANWORK, INC. STAFFORD RES
Other - Org Type:Other Name
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:WHIDDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-638-0350
Mailing Address - Street 1:PO BOX 20664
Mailing Address - Street 2:
Mailing Address - City:ST SIMONS ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31522-0264
Mailing Address - Country:US
Mailing Address - Phone:912-638-0350
Mailing Address - Fax:912-638-9030
Practice Address - Street 1:3533 STAFFORD ST
Practice Address - Street 2:
Practice Address - City:HEPHZIBAH
Practice Address - State:GA
Practice Address - Zip Code:30815-6625
Practice Address - Country:US
Practice Address - Phone:706-790-8694
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-17
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACLA000694 P320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000902063AHMedicaid