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Georgia Department of Human Resources — NPI 1083782288, Augusta, GA | NPI Central

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NPI 1083782288

OrganizationActive

Georgia Department of Human Resources

NPI 1083782288 · Intellectual Disabilities Intermediate Care Facility · Augusta, GA

Provider details

NPI number: 1083782288
Entity type: Organization
Primary specialty: Intellectual Disabilities Intermediate Care FacilityNursing & Custodial Care Facilities
Organization subpart: No
Authorized official: Gail Jackson, Regional Hospital Administrator(706) 790-2030
License: 2121792 (GA)

Specialties & taxonomies

Intellectual Disabilities Intermediate Care FacilityPrimary315P00000XLicense 2121792 (GA)
Nursing & Custodial Care Facilities

Practice location

100 Myrtle Blvd

Augusta, GA 30812-1500

Phone: (706) 790-2030

Approximate (ZIP-level) locationGet directions

More GA providers

Mailing address

100 Myrtle Blvd

Augusta, GA 30812-1500

Other names (DBA / former)

Doing business as: Ecrh-Gracewood Developmental Center

Registry dates

Enumerated: 2006-12-04
Last updated: 2020-08-22

Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.