Provider Demographics
NPI:1942088356
Name:MCINTOSH TRAIL MANAGEMENT SERVICES INC
Entity Type:Organization
Organization Name:MCINTOSH TRAIL MANAGEMENT SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TERANNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUMBELOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-567-5948
Mailing Address - Street 1:246 ODELL RD STE 5
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-4880
Mailing Address - Country:US
Mailing Address - Phone:770-567-5948
Mailing Address - Fax:
Practice Address - Street 1:246 ODELL RD STE 5
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-4880
Practice Address - Country:US
Practice Address - Phone:770-567-5948
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MCINTOSH TRAIL MANAGEMENT SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management