OrganizationActive
Chauncy Montgomery
NPI 1790094241 · Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Vidalia, GA
Provider details
- NPI number
- 1790094241
- Entity type
- Organization
- Primary specialty
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityResidential Treatment Facilities
- Organization subpart
- No
- Authorized official
- Chauncy Montgomery, Owner/Director(912) 347-2399
Specialties & taxonomies
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityPrimary320900000X
Residential Treatment Facilities
- Respite Care385H00000X
Respite Care Facility
Practice location
1114 Jr Rollins Rd
Vidalia, GA 30474-9462
Phone: (912) 537-4143
Fax: (912) 537-4143
Approximate (ZIP-level) locationGet directions
Mailing address
1114 Jr Rollins Rd
Vidalia, GA 30474-9462
Other names (DBA / former)
- Doing business as
- The Secret Place
Registry dates
- Enumerated
- 2010-10-01
- Last updated
- 2010-10-01
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.