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 Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 251C00000X | Day Training, Developmentally Disabled Services | | | | No |
| 2 | 251T00000X | Program of All-Inclusive Care for the Elderly (PACE) Provider Organization | | | FLORIDA | No |
| 3 | 251V00000X | Voluntary or Charitable | | | GEORGIA | No |
| 4 | 251V00000X | Voluntary or Charitable | | | FLORIDA | No |
| 5 | 305R00000X | Preferred Provider Organization | | | GEORGIA | No |
| 6 | 3104A0630X | Assisted Living Facility | Assisted Living, Behavioral Disturbances | | GEORGIA | No |
| 7 | 320700000X | Residential Treatment Facility, Physical Disabilities | | | FLORIDA | No |
| 8 | 347E00000X | Transportation Broker | | | GEORGIA | No |
| 9 | 320900000X | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | | | GEORGIA | Yes |
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 Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 0 | OTHER | | 0 |
| 2 | ========= | MEDICAID | GEORGIA | |
| 3 | ========= | MEDICAID | FLORIDA | |
