Provider Demographics
NPI:1609029925
Name:GEORGIA DEPARTMENT OF HUMAN RESOURCES
Entity Type:Organization
Organization Name:GEORGIA DEPARTMENT OF HUMAN RESOURCES
Other - Org Name:CENTRAL CARE (138 SWINT AVE)
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-445-8182
Mailing Address - Street 1:138 SWINT AVE SE
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-3928
Mailing Address - Country:US
Mailing Address - Phone:478-445-8182
Mailing Address - Fax:
Practice Address - Street 1:138 SWINT AVE SE
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-3928
Practice Address - Country:US
Practice Address - Phone:478-445-8182
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-30
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000355737WMedicaid