Healthcare Provider Details

I. General information

NPI: 1740472653
Provider Name (Legal Business Name): DOWNING CLARK CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2007
Last Update Date: 08/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1773 TRIMBLE HOLLOW RD SE
ADAIRSVILLE GA
30103-4041
US

IV. Provider business mailing address

1773 TRIMBLE HOLLOW RD SE
ADAIRSVILLE GA
30103-4041
US

V. Phone/Fax

Practice location:
  • Phone: 706-629-3282
  • Fax: 706-629-7892
Mailing address:
  • Phone: 706-629-3282
  • Fax: 706-629-7892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number StateGA
# 6
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number StateGA

VIII. Authorized Official

Name: MRS. KELLI BENE' CLARK
Title or Position: PRESIDENT & COO
Credential:
Phone: 706-629-3282