Willie Colquitt Host Home
Residential Treatment Facility, Intellectual and/or Developmental Disabilities in Waycross, GA. Organization (NPI-2).
NPI number1780126185
StatusActive
Last updated in NPPESNov 16, 2016
Details
- NPI
- 1780126185
- Entity type
- Organization (NPI-2)
- Legal business name
- Willie Colquitt Host Home
- Organization subpart
- No
- Enumeration date
- Nov 16, 2016
- Last updated
- Nov 16, 2016
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 320600000X | Residential Treatment Facility, Intellectual and/or Developmental Disabilities | – | GA | Yes |
Practice location
1007 Mary StWaycross, GA 31503-3823
Phone 912-449-7109 · Fax 912-449-7056
Mailing address
950 Gus Paulk RdAmbrose, GA 31512-3406
Phone 912-501-7354 · Fax 912-449-7056
Authorized official
Michelle Simpson
Billing Manager
9124497109
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