Provider Demographics
NPI:1356419097
Name:ATHENS AREA COMMENCEMENT CENTER
Entity type:Organization
Organization Name:ATHENS AREA COMMENCEMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:HINZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-475-5797
Mailing Address - Street 1:1175 MITCHELL BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-6411
Mailing Address - Country:US
Mailing Address - Phone:706-475-5797
Mailing Address - Fax:706-546-8439
Practice Address - Street 1:1175 MITCHELL BRIDGE RD
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-6411
Practice Address - Country:US
Practice Address - Phone:706-475-5797
Practice Address - Fax:706-546-8439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA029554D324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA029554DOtherSTATE LICENSE NUMBER
GA029554DOtherSTATE LICENSE NUMBER