Provider Demographics
NPI:1578190450
Name:FOUR-SIXTY INC
Entity Type:Organization
Organization Name:FOUR-SIXTY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NORWOOD
Authorized Official - Middle Name:N
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:ESQ
Authorized Official - Phone:832-454-8506
Mailing Address - Street 1:460 BERKSHIRE PL
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-2069
Mailing Address - Country:US
Mailing Address - Phone:832-454-8506
Mailing Address - Fax:
Practice Address - Street 1:4300 MARTHA BERRY HWY NE
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-8642
Practice Address - Country:US
Practice Address - Phone:678-834-7615
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-23
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No253J00000XAgenciesFoster Care Agency