OrganizationActive
On-The-Case
NPI 1992902951 · Psychiatric Residential Treatment Facility · Martinez, GA
Provider details
- NPI number
- 1992902951
- Entity type
- Organization
- Primary specialty
- Psychiatric Residential Treatment FacilityResidential Treatment Facilities
- Organization subpart
- No
- Authorized official
- Pamela Sanders, Production Officer(706) 306-5438
- License
- R101799 (SC)
Specialties & taxonomies
Residential Treatment Facilities
- Intellectual and/or Developmental Disabilities Residential Treatment Facility320600000XLicense R101799 (SC)
Residential Treatment Facilities
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility320900000XLicense R101799 (SC)
Residential Treatment Facilities
Nursing & Custodial Care Facilities
Nursing & Custodial Care Facilities
Practice location
4115 Columbia Rd
Suite 5-324
Martinez, GA 30907-0405
Phone: (706) 793-0646
Fax: (706) 793-0646
Approximate (ZIP-level) locationGet directions
Mailing address
4115 Columbia Rd
Martinez, GA 30907-0405
Other names (DBA / former)
- Doing business as
- Gypsy Rose,inc.
Registry dates
- Enumerated
- 2007-07-02
- Last updated
- 2025-09-11
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.