Provider Demographics
NPI:1558916726
Name:RE-DIRECT BEHAVIORAL YOUTH PROGRAM
Entity Type:Organization
Organization Name:RE-DIRECT BEHAVIORAL YOUTH PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:NATHAN
Authorized Official - Last Name:RICKS
Authorized Official - Suffix:
Authorized Official - Credentials:ETC
Authorized Official - Phone:478-697-5304
Mailing Address - Street 1:PO BOX 16355
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31040-6355
Mailing Address - Country:US
Mailing Address - Phone:478-697-5304
Mailing Address - Fax:
Practice Address - Street 1:900 MLK JR DR
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-5063
Practice Address - Country:US
Practice Address - Phone:478-304-1403
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management