Department of Behavioral Health and Developmental Disabilities

NPI #1699000703 in Gracewood, Georgia

Provider Information

NPI Number: 1699000703
Entity Type: Organization
Organization Name: Department of Behavioral Health and Developmental Disabilities
Primary Specialty: Intermediate Care Facility, Intellectual Disabilities
Enumeration Date: Oct 7, 2009
Last Updated: May 20, 2015

Practice Location

Address: 100 MYRTLE BLVD
City: Gracewood
State: Georgia
ZIP Code: 30812-1500
Phone: (706) 790-2030

Authorized Official

Name: MR. PAUL BROCK
Title: REGIONAL HOSPITAL ADMINISTRATOR
Phone: (706) 790-2030

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Intermediate Care Facility, Intellectual Disabilities	315P00000X	Primary

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