Provider Demographics
NPI:1568489904
Name:SAVANNAH AREA BEHAVIORAL HEALTH COLLABORTIVE
Entity Type:Organization
Organization Name:SAVANNAH AREA BEHAVIORAL HEALTH COLLABORTIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACQUILIN
Authorized Official - Middle Name:
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:912-966-3782
Mailing Address - Street 1:17 MINUS AVENUE
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:GA
Mailing Address - Zip Code:31408-2006
Mailing Address - Country:US
Mailing Address - Phone:912-966-3782
Mailing Address - Fax:912-963-2532
Practice Address - Street 1:17 MINIS AVE
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:GA
Practice Address - Zip Code:31408-2006
Practice Address - Country:US
Practice Address - Phone:912-966-3782
Practice Address - Fax:912-963-2532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW003465104100000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA305328035AMedicaid
GAGRP6473OtherMEDICARE GROUP
GAE78663Medicare UPIN