Provider Demographics
NPI:1538336524
Name:GWINNETT, ROCKDALE & NEWTON COMMUNITY SERVICE BOARD
Entity type:Organization
Organization Name:GWINNETT, ROCKDALE & NEWTON COMMUNITY SERVICE BOARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DAY SERVICES COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:JO
Authorized Official - Last Name:CALANDRINO
Authorized Official - Suffix:
Authorized Official - Credentials:MS MHP CPRP
Authorized Official - Phone:770-995-6902
Mailing Address - Street 1:595 OLD NORCROSS RD STE C
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-7667
Mailing Address - Country:US
Mailing Address - Phone:770-995-6902
Mailing Address - Fax:
Practice Address - Street 1:595 OLD NORCROSS RD STE C
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-7667
Practice Address - Country:US
Practice Address - Phone:770-995-6902
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization