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General NPI Number Information
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NPI Number | 1811731235
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Entity Type | Organization
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Legal Business Name | RESILIENCE BEHAVIORAL HEALTH GEORGIA
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Dates
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Enumeration Date | 06/20/2024
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Last Update Date | 12/15/2025
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Provider Practice Location Address
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Address Line | 200 WESTPARK DR STE 100
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-3527
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Country | US
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Telephone | 781-472-0247
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Fax |
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Provider Business Mailing Address
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Address Line | 1600 PROVIDENCE HWY STE 100
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City | WALPOLE
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State | MA
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Zip | 02081-2557
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | MATTHEW DINICOLA
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Credential |
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Telephone | 781-472-0247
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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