Healthcare Provider Details

I. General information

NPI: 1497473904
Provider Name (Legal Business Name): HALO GROUP OF MIDDLE GEORGIA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2022
Last Update Date: 08/19/2022
Certification Date: 08/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 BALL ST
PERRY GA
31069-3459
US

IV. Provider business mailing address

PO BOX 1078
PERRY GA
31069-1078
US

V. Phone/Fax

Practice location:
  • Phone: 478-224-4866
  • Fax:
Mailing address:
  • Phone: 478-224-4866
  • 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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: ANGELA CUTI
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 478-955-8119