Healthcare Provider Details

I. General information

NPI: 1497499230
Provider Name (Legal Business Name): GRIFFIN AREA RESOURCE CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2022
Last Update Date: 04/27/2022
Certification Date: 04/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

931 HAMILTON BLVD
GRIFFIN GA
30223-4430
US

IV. Provider business mailing address

PO BOX 847
GRIFFIN GA
30224-0022
US

V. Phone/Fax

Practice location:
  • Phone: 770-228-9919
  • Fax:
Mailing address:
  • Phone: 770-228-9919
  • Fax:

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
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: LAURA WALLACE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 770-228-9919