=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750384368
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DEPARTMENT OF HUMAN SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/27/2005
-----------------------------------------------------
Last Update Date | 08/24/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6135 ROOSEVELT HWY
-----------------------------------------------------
City | WARM SPRINGS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31830-1000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-655-5598
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1000
-----------------------------------------------------
City | WARM SPRINGS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31830-1000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-655-5598
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | MRS. ELIZABETH A POSTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 706-655-5609
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 283X00000X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Hospital
-----------------------------------------------------
License Number | 099 287
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------