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MCINTOSH TRAIL CSB NPI 1750569919


NPI Information

NPI: 1750569919
Provider Name: MCINTOSH TRAIL CSB

Doing Business As: FAYETTE COMMUNITY OPTIONS

Classification: Community/Behavioral Health - 251S00000X
Entity Type: Organization

CLIA Number: 11D2268237

Address:
160 CARNEGIE PL
FAYETTEVILLE, GA
ZIP 30214
Phone: (770) 461-1351
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MCINTOSH TRAIL CSB is a community behavioral health in Fayetteville, GA. The provider is a private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, intellectual disabilities, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. MCINTOSH TRAIL CSB NPI is 1750569919. The provider is registered as an organization entity type.
The provider Is Doing Business As Fayette Community Options.

The provider's business location address is:

160 CARNEGIE PL
FAYETTEVILLE, GA
ZIP 30214-905
Phone: (770) 461-1351

The provider's authorized official is Mike Hubbard .
The authorized official title is Ceo and has the following contact phone number (770) 358-8251.

The CLIA number assigned to this NPI record is 11D2268237 - school/student health service with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/8/2008 and was last updated on 12/17/2015.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1251S00000XCommunity/Behavioral HealthYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1000603435KMEDICAIDGEORGIA
2000603435JMEDICAIDGEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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