Provider Demographics
NPI:1285750745
Name:THE SALVATION ARMY A GEORGIA CORPORATION
Entity type:Organization
Organization Name:THE SALVATION ARMY A GEORGIA CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R N
Authorized Official - Last Name:GOODIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-728-1300
Mailing Address - Street 1:1424 NORTHEAST EXPRESSWAY NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329
Mailing Address - Country:US
Mailing Address - Phone:404-728-1300
Mailing Address - Fax:404-728-8756
Practice Address - Street 1:305 SHANDS DR
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904
Practice Address - Country:US
Practice Address - Phone:936-634-1234
Practice Address - Fax:936-634-0765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116555261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care