Provider Demographics
NPI:1689993461
Name:BULLOCH RECOVERY RESOURCES
Entity Type:Organization
Organization Name:BULLOCH RECOVERY RESOURCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:MITCHELL
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-489-8401
Mailing Address - Street 1:18 SIMMONS CENTER
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458
Mailing Address - Country:US
Mailing Address - Phone:912-489-8401
Mailing Address - Fax:912-489-4316
Practice Address - Street 1:18 SIMMONS CENTER
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458
Practice Address - Country:US
Practice Address - Phone:912-489-8401
Practice Address - Fax:912-489-4316
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BULLOCH DUI RISK REDUCTION, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-05-19
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2010000179261QA0005X, 261QM0801X, 261QM0850X, 261QM0855X, 261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health