SHALLOWFORD GROUP HOME (NPI# 1306981113) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306981113 |
| Entity Type | Organization |
| Organization Name | SHALLOWFORD GROUP HOME |
| Other Organization Name | SHALLOWFORD GROUP HOME |
| Practice Address |
2473 Shallowford Rd Ne Atlanta GA 30345-1363 |
| Mailing Address |
445 Winn Way Fl 4 Decatur GA 30030-1707 |
| Practice Telephone | 4046360955 |
| Practice Fax Number | 4046360955 |
| Mailing Telephone | 4045087796 |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2020-04-22 |
| Authorized Official Name | FABIO BRUNO VAN DER MERWE (COO) |
| Authorized Official Telephone | 4042943836 |
| Is Organization Subpart | Y |
| Parent Organization Name | DEKALB COMMUNITY SERVICE BOARD |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 251S00000X | Community/Behavioral Health | Agencies |
| Other Name | Type Code |
|---|---|
| Shallowford Group Home | Other Name - Individual/Organization |
| Street Address |
2473 SHALLOWFORD RD NE |
| City | ATLANTA |
| State | GA |
| Zip Code | 30345-1363 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306358726 | Marian Barton Kalvert | Counselor | 2300 Henderson Mill Rd Ne Ste 310, Atlanta, GA 30345 | 2017-10-25 |
| 1417478439 | Reexist Counseling LLC | Clinic/Center | 1955 Vance Drive Ne, Atlanta, GA 30345 | 2017-06-29 |
| 1366862930 | Creative Behavior Consulting | Counselor | 6212 Northlake Circle Ne, Atlanta, GA 30345 | 2014-04-22 |
| 1215375209 | Shakeia Cowan | Counselor | 2302 Parklake Drive, Suite 350, Atlanta, GA 30345 | 2013-06-12 |
| 1154673259 | Phyllis Carrera | Counselor | 1788-b Century Blvd, Atlanta, GA 30345 | 2012-10-12 |
| 1417216128 | Procare Pharmacy, LLC | Pharmacy | 2700 Northeast Expy Ne, Suite B-800, Atlanta, GA 30345 | 2012-05-15 |
| 1962794479 | Nicole Renee Buttery | Behavioral Analyst | 1776 Century Blvd Ne Ste A, Atlanta, GA 30345 | 2011-05-03 |
| 1972839371 | Barbara Lopes Cardozo | Psychiatry & Neurology | 2500 Century Blvd, Mailstop V 25-1, Atlanta, GA 30345 | 2009-10-20 |
| 1568615193 | Zouheir A Shama Sr. | Surgery | 2536 Cosmos Drive N.e., Atlanta, GA 30345 | 2008-10-28 |
| 1396930558 | Munir Kashlan | Dentist | 4800 Briarcliff Rd, Ste 2037 American Dental Group Dba Great Expressions, Atlanta, GA 30345 | 2007-09-11 |
| Find all providers in zip 30345 | ||||
| Taxonomy Code | 251S00000X |
| Grouping | Agencies |
| Classification | Community/Behavioral Health |
| A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, mental retardation, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. |
| Notes: Source: National Medicaid EDI HIPAA NPI Sub Work Group [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952914632 | Brighter Dayz, Incorporated | Community/Behavioral Health | 1016 Howell Mill Rd Nw Apt 4408, Atlanta, GA 30318-5592 | 2020-08-24 |
| 1699387688 | Rise Rehabilitation Services, LLC | Community/Behavioral Health | 738 Highland Park Trl, Atlanta, GA 30350-6706 | 2020-08-20 |
| 1700427820 | Trust2change, LLC. | Community/Behavioral Health | 2900 Chamblee Tucker Rd Bldg 8, Atlanta, GA 30341-4100 | 2019-09-30 |
| 1538712088 | Ferris Healthcare Group | Community/Behavioral Health | 2900 Paces Ferry Rd Se Bldg C, Atlanta, GA 30339-5702 | 2019-07-23 |
| 1245890987 | Soc Integrated Services, LLC | Community/Behavioral Health | 130 Wynfield Way Sw, Atlanta, GA 30331-6837 | 2019-06-15 |
| 1770046740 | Z-one Incorporated | Community/Behavioral Health | 505 Tufton Trl Se, Atlanta, GA 30354-2867 | 2019-04-08 |
| 1003377086 | Chris 180, Inc. | Community/Behavioral Health | 3700 Martin Luther King Dr Sw, Atlanta, GA 30331-3674 | 2019-03-30 |
| 1144790783 | Danielle Smith | Community/Behavioral Health | 880 Glenwood Ave Se Unit 3185, Atlanta, GA 30316-1955 | 2018-11-27 |
| 1073083762 | Michael Pollock | Community/Behavioral Health | 3725 Princeton Lakes Pkwy Sw Apt 7003, Atlanta, GA 30331-5560 | 2018-11-26 |
| 1851881353 | Atlanta Life Journeys Services, LLC | Community/Behavioral Health | 3196 Dogwood Dr, Atlanta, GA 30354-1149 | 2018-05-10 |
| Find all providers in ATLANTA | ||||
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| 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.