Provider Demographics
NPI:1073660528
Name:EASTER SEALS WEST GEORGIA, INC
Entity type:Organization
Organization Name:EASTER SEALS WEST GEORGIA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE/ACCOUNTING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:GREGORY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-221-4425
Mailing Address - Street 1:PO BOX 1690
Mailing Address - Street 2:
Mailing Address - City:FORTSON
Mailing Address - State:GA
Mailing Address - Zip Code:31808-1690
Mailing Address - Country:US
Mailing Address - Phone:706-660-1144
Mailing Address - Fax:
Practice Address - Street 1:2515 DOUBLE CHURCHES RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-2742
Practice Address - Country:US
Practice Address - Phone:706-660-1144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0033260601DMedicaid
GA000551405QMedicaid