Provider Demographics
NPI:1619208519
Name:BYRD HOUSE-BEHAVIORAL YOUTH RESOURCE DEVELOPMENT, INC
Entity Type:Organization
Organization Name:BYRD HOUSE-BEHAVIORAL YOUTH RESOURCE DEVELOPMENT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:EDITH
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:BYRD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-423-3200
Mailing Address - Street 1:PO BOX 72001
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30271-2001
Mailing Address - Country:US
Mailing Address - Phone:678-423-3200
Mailing Address - Fax:
Practice Address - Street 1:19 PERRY ST
Practice Address - Street 2:SUITE 202
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-1918
Practice Address - Country:US
Practice Address - Phone:678-423-3200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-18
Last Update Date:2010-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 253J00000X
GA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No253J00000XAgenciesFoster Care Agency