Healthcare Provider Details

I. General information

NPI: 1720351851
Provider Name (Legal Business Name): HAPPY VALLEY DAY FACILITY II LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2012
Last Update Date: 02/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 2ND AVE
COLUMBUS GA
31901
US

IV. Provider business mailing address

600 2ND AVE
COLUMBUS GA
31901-2906
US

V. Phone/Fax

Practice location:
  • Phone: 706-322-7185
  • Fax: 706-322-7199
Mailing address:
  • Phone: 706-322-7185
  • Fax: 706-322-7199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TAMIKO MICHELL PARKER
Title or Position: DIRECTOR
Credential:
Phone: 706-322-7185