1245385087 NPI number — OGEECHEE BEHAVIORAL HEALTH SERVICES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245385087 NPI number — OGEECHEE BEHAVIORAL HEALTH SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OGEECHEE BEHAVIORAL HEALTH SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245385087
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
223 N. ANDERSON DRIVE
Provider Second Line Business Mailing Address:
P O BOX 1259
Provider Business Mailing Address City Name:
SWAINSBORO
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30401-1259
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1114 CLARKS MILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30434-5304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
478-625-7214
Provider Business Practice Location Address Fax Number:
478-625-7240
Provider Enumeration Date:
01/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BRANTLEY
Authorized Official First Name:
J
Authorized Official Middle Name:
FRANK
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
478-289-2522

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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