NPI 1780126185

Willie Colquitt Host Home

Organisation Intellectual and/or Developmental Disabilities Residential Treatment Facility Waycross, GA

Practice location

Address: 1007 Mary St, Waycross, GA 31503-3823
Phone: (912) 449-7109
Fax: (912) 449-7056
Mailing address: 950 Gus Paulk Rd, Ambrose, GA 31512-3406

Authorised official

Name: Michelle Simpson
Title: Billing Manager
Phone: (912) 449-7109

Registered specialties

Intellectual and/or Developmental Disabilities Residential Treatment Facility Primary

Residential Treatment Facilities Taxonomy 320600000X

Other Residential Treatment Facility, Intellectual and/or Developmental Disabilities providers in Georgia →

Registry record

NPI: 1780126185
Entity type: Organization
NPI issued: 16 Nov 2016
Record last updated: 16 Nov 2016

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.