Provider Demographics
NPI:1750583670
Name:MORNINGSTAR CHILDREN AND FAMILY SERVICES, INC.
Entity type:Organization
Organization Name:MORNINGSTAR CHILDREN AND FAMILY SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:WELLS
Authorized Official - Middle Name:
Authorized Official - Last Name:KILGORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-267-3700
Mailing Address - Street 1:P.O. BOX 370
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31521
Mailing Address - Country:US
Mailing Address - Phone:912-267-7583
Mailing Address - Fax:912-267-9568
Practice Address - Street 1:3596 DARIEN HWY
Practice Address - Street 2:SUITES 4 & 5
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31525-3034
Practice Address - Country:US
Practice Address - Phone:912-267-3701
Practice Address - Fax:912-267-0235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACCI0000011057251S00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA860119541AMedicaid