Provider Demographics
NPI:1659023604
Name:DOUGLASVILLE ISLAMIC WOMEN'S SHELTER AND SERVICES, INC
Entity Type:Organization
Organization Name:DOUGLASVILLE ISLAMIC WOMEN'S SHELTER AND SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NATYSHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:BSW, MSW
Authorized Official - Phone:470-427-5440
Mailing Address - Street 1:8486 CAMPBELLTON ST
Mailing Address - Street 2:#244
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30133
Mailing Address - Country:US
Mailing Address - Phone:470-427-5400
Mailing Address - Fax:470-427-5443
Practice Address - Street 1:4970 WYNFORD LN
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-8012
Practice Address - Country:US
Practice Address - Phone:704-427-5400
Practice Address - Fax:470-427-5443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-21
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase Management
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No251300000XAgenciesLocal Education Agency (LEA)
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health
No251V00000XAgenciesVoluntary or Charitable
No252Y00000XAgenciesEarly Intervention Provider Agency
No253Z00000XAgenciesIn Home Supportive Care
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No305S00000XManaged Care OrganizationsPoint of Service
No332U00000XSuppliersHome Delivered Meals
No333300000XSuppliersEmergency Response System Companies
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)