Provider Demographics
NPI:1912273376
Name:PATRICIA WALKER HOST HOME
Entity Type:Organization
Organization Name:PATRICIA WALKER HOST HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-449-7111
Mailing Address - Street 1:P O BOX 776
Mailing Address - Street 2:
Mailing Address - City:HOMERVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31634
Mailing Address - Country:US
Mailing Address - Phone:912-487-3313
Mailing Address - Fax:
Practice Address - Street 1:1007 MARY ST
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31503-3823
Practice Address - Country:US
Practice Address - Phone:912-449-7111
Practice Address - Fax:912-449-7060
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SATILLA COMMUNITY SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health