Provider Demographics
NPI:1316345002
Name:GAINESVILLE CLEARING HOUSE, INC
Entity type:Organization
Organization Name:GAINESVILLE CLEARING HOUSE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LLOYD
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:JR
Authorized Official - Credentials:CAC II
Authorized Official - Phone:770-539-9669
Mailing Address - Street 1:PO BOX 2323
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30503-2323
Mailing Address - Country:US
Mailing Address - Phone:770-539-9669
Mailing Address - Fax:770-539-9522
Practice Address - Street 1:322 SPRING ST SE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3736
Practice Address - Country:US
Practice Address - Phone:770-539-9669
Practice Address - Fax:770-539-9522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-11
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1451324500000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilityGroup - Multi-Specialty