Provider Demographics
NPI:1609411321
Name:PENFIELD ADDICTION MINISTRIES, INC.
Entity Type:Organization
Organization Name:PENFIELD ADDICTION MINISTRIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CQI-RM SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:METZGER
Authorized Official - Suffix:
Authorized Official - Credentials:CADCI
Authorized Official - Phone:706-817-4589
Mailing Address - Street 1:1061 MERCER CIR
Mailing Address - Street 2:
Mailing Address - City:UNION POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30669-2205
Mailing Address - Country:US
Mailing Address - Phone:706-453-7929
Mailing Address - Fax:
Practice Address - Street 1:1061 MERCER CIR
Practice Address - Street 2:
Practice Address - City:UNION POINT
Practice Address - State:GA
Practice Address - Zip Code:30669-2205
Practice Address - Country:US
Practice Address - Phone:706-453-7929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-18
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty