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1500 Champions Pines Ln Apt 416 Augusta GA 30909-5510 | |
| (912) 706-8170 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Community Based Residential Treatment Facility, Mental Illness |
| Location | 1500 Champions Pines Ln Apt 416, Augusta, Georgia |
| Authorized Official Name and Position | Patrick Waters (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 7062008677 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1727 Wrightsboro Rd Ste B Augusta GA 30904-4049 Ph: (706) 736-8170 | 1500 Champions Pines Ln Apt 416 Augusta GA 30909-5510 Ph: (912) 706-8170 |
| NPI Number | 1073264313 |
|---|---|
| Provider Enumeration Date | 01/18/2022 |
| Last Update Date | 07/10/2024 |
| Certification Date | 07/10/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073264313 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| 320800000X | Community Based Residential Treatment Facility, Mental Illness | (* (Not Available)) | Primary |
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