Provider Demographics
NPI:1295738540
Name:CHILDREN & ADULT THERAPY SERVICES
Entity type:Organization
Organization Name:CHILDREN & ADULT THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:770-207-9043
Mailing Address - Street 1:226 ALCOVY ST
Mailing Address - Street 2:STE G-1
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655-2183
Mailing Address - Country:US
Mailing Address - Phone:770-207-9043
Mailing Address - Fax:770-207-9029
Practice Address - Street 1:226 ALCOVY ST
Practice Address - Street 2:STE G-1
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-2183
Practice Address - Country:US
Practice Address - Phone:770-207-9043
Practice Address - Fax:770-207-9029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA116745225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA116745Medicare ID - Type UnspecifiedOUT PATIENT REHAB