Provider Demographics
NPI:1487961942
Name:IRIE'S COMMUNITY DEVELOPMENT CENTER, INC
Entity type:Organization
Organization Name:IRIE'S COMMUNITY DEVELOPMENT CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:J
Authorized Official - Last Name:TOWNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-353-8500
Mailing Address - Street 1:5495 OLD NATIONAL HWY STE C1
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30349-3256
Mailing Address - Country:US
Mailing Address - Phone:470-357-2561
Mailing Address - Fax:470-357-2564
Practice Address - Street 1:112 MALL RD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-3035
Practice Address - Country:US
Practice Address - Phone:404-835-3215
Practice Address - Fax:404-835-3217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-06
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003143622AMedicaid
GA003204906AMedicaid
GA003140721AMedicaid
GA003204906BMedicaid