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NPI 1669922332 · Intellectual and/or Developmental Disabilities Residential Treatment Facility · Waycross, GA
Provider details
- NPI number
- 1669922332
- Entity type
- Organization
- Primary specialty
- Intellectual and/or Developmental Disabilities Residential Treatment FacilityResidential Treatment Facilities
- Organization subpart
- No
- Authorized official
- Michelle Simpson, Billing Manager(912) 449-7109
Specialties & taxonomies
Residential Treatment Facilities
Profile Score
Established profile(71/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
9 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
1007 Mary St
Waycross, GA 31503-3823
Phone: (912) 449-7109
Street-level locationGet directions
Mailing address
1314 Elizabeth St
Waycross, GA 31503-3935
Registry dates
- Enumerated
- 2016-10-06
- Last updated
- 2016-10-06
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.