Provider Demographics
NPI:1801332150
Name:RIVERMEND HEALTH CENTERS, LLC OF GEORGIA
Entity type:Organization
Organization Name:RIVERMEND HEALTH CENTERS, LLC OF GEORGIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF RCM
Authorized Official - Prefix:
Authorized Official - First Name:TYEAST
Authorized Official - Middle Name:
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-813-0428
Mailing Address - Street 1:2300 WINDY RIDGE PKWY SE
Mailing Address - Street 2:SUIET 210S
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-5665
Mailing Address - Country:US
Mailing Address - Phone:678-813-0505
Mailing Address - Fax:678-813-0505
Practice Address - Street 1:1640 POWERS FERRY RD SE
Practice Address - Street 2:BUILDING 6, SUIET 100
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-5491
Practice Address - Country:US
Practice Address - Phone:678-813-0505
Practice Address - Fax:678-813-0505
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RIVERMEND HEALTH, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-10
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033-421-D261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder