Provider Demographics
NPI: | 1942270558 |
---|---|
Name: | ADVANTAGE BEHAVIORAL HEALTH SYSTEMS |
Entity Type: | Organization |
Organization Name: | ADVANTAGE BEHAVIORAL HEALTH SYSTEMS |
Other - Org Name: | CLARKE MH |
Other - Org Type: | Other Name |
Authorized Official - Title/Position: | BILLING MANAGER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | GLENN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | BUTLER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 706-227-7204 |
Mailing Address - Street 1: | 250 NORTH AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | ATHENS |
Mailing Address - State: | GA |
Mailing Address - Zip Code: | 30601-2244 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 706-542-9700 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 250 NORTH AVE |
Practice Address - Street 2: | |
Practice Address - City: | ATHENS |
Practice Address - State: | GA |
Practice Address - Zip Code: | 30601-2244 |
Practice Address - Country: | US |
Practice Address - Phone: | 706-542-9739 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-01-25 |
Last Update Date: | 2008-02-12 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
No | 261QD1600X | Ambulatory Health Care Facilities | Clinic/Center | Developmental Disabilities |
No | 261QE0002X | Ambulatory Health Care Facilities | Clinic/Center | Emergency Care |
No | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health |
No | 261QM0855X | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health |
No | 261QR0405X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder |
No | 320600000X | Residential Treatment Facilities | Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
No | 320800000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness | |
No | 320900000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
No | 322D00000X | Residential Treatment Facilities | Residential Treatment Facility, Emotionally Disturbed Children | |
No | 323P00000X | Residential Treatment Facilities | Psychiatric Residential Treatment Facility | |
No | 324500000X | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | |
No | 385HR2055X | Respite Care Facility | Respite Care | Respite Care, Mental Illness, Child |
No | 385HR2060X | Respite Care Facility | Respite Care | Respite Care, Intellectual and/or Developmental Disabilities, Child |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
GA | GRP2219 | Medicare ID - Type Unspecified | MEDICARE GROUP NUMBER |