NPI 1699000703

Department of Behavioral Health and Developmental Disabilities

Organisation Intellectual Disabilities Intermediate Care Facility Gracewood, GA

Practice location

Address: 100 Myrtle Blvd, Gracewood, GA 30812-1500
Phone: (706) 790-2030
Fax: (706) 790-2025

Authorised official

Name: Paul Brock
Title: Regional Hospital Administrator
Phone: (706) 790-2030

Registered specialties

Intellectual Disabilities Intermediate Care Facility Primary

Nursing & Custodial Care Facilities Taxonomy 315P00000X Licence 2-121-792 (GA)

Other Intermediate Care Facility, Intellectual Disabilities providers in Georgia →

Registry record

NPI: 1699000703
Entity type: Organization
NPI issued: 7 Oct 2009
Record last updated: 20 May 2015

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.