Healthcare Provider Details

I. General information

NPI: 1558632968
Provider Name (Legal Business Name): AMERICANWORK, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2012
Last Update Date: 01/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3533 STAFFORD ST
HEPHZIBAH GA
30815-6625
US

IV. Provider business mailing address

PO BOX 20664
ST SIMONS ISLAND GA
31522-0264
US

V. Phone/Fax

Practice location:
  • Phone: 706-790-8694
  • Fax:
Mailing address:
  • Phone: 912-638-0350
  • Fax: 912-638-9030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License NumberCLA000694 P
License Number StateGA

VIII. Authorized Official

Name: WILLIAM KENNETH WHIDDON
Title or Position: COO
Credential:
Phone: 912-638-0350