Provider Demographics
NPI:1992047278
Name:BURNING BUSH YOUTH & FAMILY INTERVENTION CENTER, INC.
Entity type:Organization
Organization Name:BURNING BUSH YOUTH & FAMILY INTERVENTION CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:TINSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-774-8230
Mailing Address - Street 1:144 BROOKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:GA
Mailing Address - Zip Code:30233-1403
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:144 BROOKWOOD AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:GA
Practice Address - Zip Code:30233-1403
Practice Address - Country:US
Practice Address - Phone:678-774-8230
Practice Address - Fax:678-774-8233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-25
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251K00000XAgenciesPublic Health or Welfare
No251V00000XAgenciesVoluntary or Charitable