1770629909 NPI number — NEW HORIZONS CSB QUITMAN ADULT 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 1770629909 NPI number — NEW HORIZONS CSB QUITMAN ADULT SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW HORIZONS CSB QUITMAN ADULT 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:
1770629909
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:
2100 COMER AVE.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31904
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-596-5586
Provider Business Mailing Address Fax Number:
706-596-5589

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
GOVERNMENT AND HEALTH COMPLES
Provider Second Line Business Practice Location Address:
BUILDING 4 HARRISON ST.
Provider Business Practice Location Address City Name:
GEORGETOWN
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
39854
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-334-0900
Provider Business Practice Location Address Fax Number:
229-334-0906
Provider Enumeration Date:
01/29/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ALEXANDER
Authorized Official First Name:
PERRY
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
706-596-5582

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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