CLAYTON MHDDAD (NPI# 1104082866) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104082866 |
| Entity Type | Organization |
| Organization Name | CLAYTON MHDDAD |
| Other Organization Name | CLAYTON CENTER CSB |
| Practice Address |
269 Valley Hill Rd Sw Riverdale GA 30274-2745 |
| Mailing Address |
112 Broad St Jonesboro GA 30236-3563 |
| Practice Telephone | 7704782280 |
| Mailing Telephone | 7704782280 |
| Mailing Fax Number | 7704779772 |
| Enumeration Date | 2008-08-01 |
| Last Update Date | 2008-08-01 |
| Authorized Official Name | MR. JADE BENEFIELD (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 7704782280 |
| Is Organization Subpart | Y |
| Parent Organization Name | CLAYTON MHDDAD |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 251S00000X | Community/Behavioral Health | Agencies | ||
| N | 261QD1600X |
Clinic/Center Specialization: Developmental Disabilities |
Ambulatory Health Care Facilities | ||
| N | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
Ambulatory Health Care Facilities | ||
| N | 261QM0850X |
Clinic/Center Specialization: Adult Mental Health |
Ambulatory Health Care Facilities | ||
| Y | 251C00000X | Day Training, Developmentally Disabled Services | Agencies |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 000606922AM | 05 |
| Other Name | Type Code |
|---|---|
| Clayton Center CSB | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518113869 | Clayton Mhddad | Community/Behavioral Health | 1044 Pinecrest Dr, Forest Park, GA 30297-3335 | 2008-08-18 |
| 1427204775 | Clayton Mhddad | Community/Behavioral Health | 6278 Holiday Blvd, Forest Park, GA 30297-4262 | 2008-08-18 |
| 1386890341 | Clayton Mhddad | Community/Behavioral Health | 6944 Fielder Rd, Rex, GA 30273-2414 | 2008-08-11 |
| 1639358906 | Clayton Mhddad | Clinic/Center | 1585 Pintail Rd, Jonesboro, GA 30238-6641 | 2007-11-02 |
| 1679761373 | Clayton Mhddad | Clinic/Center | 2081 Logan Dr, Jonesboro, GA 30236-7215 | 2007-10-09 |
| 1942498647 | Clayton Mhddad | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 5800 Lillian Ln, Morrow, GA 30260-3965 | 2007-10-09 |
| 1851589550 | Clayton Mhddad | Clinic/Center | 7814 Fielder Rd, Jonesboro, GA 30236-2610 | 2007-10-09 |
| 1588852289 | Clayton Mhddad | Clinic/Center | 5818 Thompson Blvd, Morrow, GA 30260-3910 | 2007-10-09 |
| 1497943104 | Clayton Mhddad | Clinic/Center | 901 Walnut Creek Ln, Jonesboro, GA 30238-6465 | 2007-10-09 |
| 1760670467 | Clayton Mhddad | Clinic/Center | 9698 Holly Hill Way, Jonesboro, GA 30238-6490 | 2007-10-09 |
| Street Address |
269 VALLEY HILL RD SW |
| City | RIVERDALE |
| State | GA |
| Zip Code | 30274-2745 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245862507 | Todd L. Reed | Chiropractor | 83 Upper Riverdale Rd, Riverdale, GA 30274 | 2020-02-05 |
| 1487135992 | Freddie L Sallette IIi | Technician, Pathology | 385 Brookview Dr, Riverdale, GA 30274 | 2018-08-22 |
| 1366933210 | Dawn A. Paul | Nurse Practitioner | 238 Professional Ct Ste A, Riverdale, GA 30274 | 2018-05-27 |
| 1851894588 | Absolute Health Family & Urgent Care Clinic | Clinic/Center | 7574 Ga 85, Riverdale, GA 30274 | 2018-03-08 |
| 1366972127 | Jamillah Ingram | Physical Therapy Assistant | 315 Upper Riverdale Rd., Riverdale, GA 30274 | 2017-06-14 |
| 1114456514 | Grace L Kelson | Licensed Practical Nurse | 9142 Clubhouse Dr, Riverdale, GA 30274 | 2017-06-08 |
| 1790167799 | Cristian Carbuccia | Internal Medicine | 33 Upper Riverdale Rd Sw Ste 10, Riverdale, GA 30274 | 2015-06-25 |
| 1265857692 | Right Choice Enterprises LLC | Technician | 638 Sterling Ct, Riverdale, GA 30274 | 2014-02-21 |
| 1942571625 | Lowes Guardian Angel LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 7056 Eunice Dr., Riverdale, GA 30274 | 2012-01-26 |
| 1508134156 | Education System Management, Inc | Social Worker | 125 Highway 138, Riverdale, GA 30274 | 2011-12-12 |
| Find all providers in zip 30274 | ||||
| Taxonomy Code | 251C00000X |
| Grouping | Agencies |
| Classification | Day Training, Developmentally Disabled Services |
| These agencies are authorized to provide day habilitation services to developmentally disabled individuals who live in their homes. The function of day habilitation is to assist an individual to acquire and maintain those life skills that enable the individual to cope more effectively with the demands of independent living. Also to raise the level of the individual's physical, mental, social, and vocational functioning. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487070892 | Sonya Decruiz- Dorcelian | Day Training, Developmentally Disabled Services | 2089 Conkle Ct, Riverdale, GA 30296-2821 | 2014-03-10 |
| 1376692723 | Creative Options & Employment, LLC | Day Training, Developmentally Disabled Services | 4705 Queensbury Rd, Riverdale, MD 20737-1920 | 2007-01-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609482397 | A Better Life Together, Inc | Day Training, Developmentally Disabled Services | 3343 Woodshade Drive, Loganville, GA 30052 | 2020-09-18 |
| 1225643653 | Auesome Achiever LLC | Day Training, Developmentally Disabled Services | 601 Alcovy St, Monroe, GA 30655-2145 | 2020-09-11 |
| 1457962797 | Southeastern Support Care Services LLC | Day Training, Developmentally Disabled Services | 3523 Fuller St, Columbus, GA 31907-2554 | 2020-08-11 |
| 1548870363 | Heart Helping Hands, LLC | Day Training, Developmentally Disabled Services | 1919 Singer Way, Lithonia, GA 30058-5578 | 2020-08-06 |
| 1073121646 | Jo Anne Ragsdale | Day Training, Developmentally Disabled Services | 4916 Lake Park Ln, Acworth, GA 30101-6253 | 2020-07-20 |
| 1447877683 | Jeremy's Place Inc. | Day Training, Developmentally Disabled Services | 4910 Jonesboro Rd Ste 201, Union City, GA 30291-2087 | 2020-07-04 |
| 1457970626 | The J&r Group Ga I Nc. | Day Training, Developmentally Disabled Services | 1910 Wood Valley Rd, Macon, GA 31211-1619 | 2020-04-08 |
| 1497307425 | Bobby Dodd Institute | Day Training, Developmentally Disabled Services | 2120 Marietta Blvd Nw, Atlanta, GA 30318-2122 | 2019-07-10 |
| 1619537453 | Cherryl Miller | Day Training, Developmentally Disabled Services | 1499 Ravenel Rd, Conley, GA 30288-2226 | 2019-06-14 |
| 1821555913 | Community Service Board of Middle Georgia | Day Training, Developmentally Disabled Services | 1444 Morgan Creek Dr, Eastman, GA 31023 | 2019-02-25 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on CLAYTON MHDDAD.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.