MAIN STREET RESIDENTIAL LIVING (NPI# 1568974285) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1568974285 |
| Entity Type | Organization |
| Organization Name | MAIN STREET RESIDENTIAL LIVING |
| Other Organization Name | MAIN STREET RESIDENTIAL LIVING |
| Practice Address |
615 W Main St Thomaston GA 30286-3580 |
| Mailing Address |
Po Box 3469 Peachtree City GA 30269-7469 |
| Practice Telephone | 9126589238 |
| Enumeration Date | 2017-11-03 |
| Last Update Date | 2018-06-16 |
| Authorized Official Name | CHRYSTAL YORK (OWNER/ADMINISTRATOR) |
| Authorized Official Telephone | 9126589238 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320900000X | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | Residential Treatment Facilities |
| Other Name | Type Code |
|---|---|
| Main St | Doing Business As Name - Organization |
| Main Street Residential Living | Doing Business As Name - Organization |
| Street Address |
615 W MAIN ST |
| City | THOMASTON |
| State | GA |
| Zip Code | 30286-3580 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295037877 | S&y Personal Care Home | Clinic/Center | 615 W Main St, Thomaston, GA 30286-3580 | 2010-12-02 |
| 1740581123 | S&y Personal Care Home | Community Based Residential Treatment Facility, Mental Illness | 615 W Main St, Thomaston, GA 30286-3580 | 2010-11-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093190670 | Careconnect Health, Inc. | Clinic/Center | 101 Deluxe Circle, Suite B, Thomaston, GA 30286 | 2015-07-24 |
| 1366859092 | Rhanada Shanae Wyche | Licensed Practical Nurse | 1226 Trice Cemetery Spur, Thomaston, GA 30286 | 2014-07-15 |
| 1083842918 | Upson Family Physicians, Lc | Family Medicine | 612 West Gordon Street, Suite C, Thomaston, GA 30286 | 2009-06-30 |
| 1942421557 | Melanie B Jackson | Licensed Practical Nurse | 605 West Gordon, Thomaston, GA 30286 | 2007-05-01 |
| 1114064540 | Kevin Lee Delli-gatti | Pediatrics | 403 W Gordon St, Thomaston, GA 30286 | 2007-02-01 |
| 1356487367 | Fuller Life Chiropractic Center | Chiropractor | 1619 Hwy 19 North, Thomaston, GA 30286 | 2007-01-29 |
| 1013072339 | Tommy Wayne Farr | Dentist | 98 Short E St, Thomaston, GA 30286 | 2006-12-27 |
| 1841301900 | Kenneth Murray Deen | Ophthalmology | 232 Cherokee Road, Thomaston, GA 30286 | 2006-08-31 |
| 1659489987 | William B Gardner | Dentist | 507 W Gordon St, Thomaston, GA 30286 | 2006-08-28 |
| 1619936895 | Sabrina M. Lancaster | Nurse Practitioner | 503 West Grodon St, Thomaston, GA 30286 | 2006-03-17 |
| Find all providers in zip 30286 | ||||
| Taxonomy Code | 320900000X |
| Grouping | Residential Treatment Facilities |
| Classification | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
| A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851839757 | Stephanie E Truman | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 78 Beechwood St, Thomaston, ME 04861-3621 | 2017-02-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790385862 | Hickory Log Vocational School Inc | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 3680 Highway 411 Ne, White, GA 30184-2427 | 2020-10-28 |
| 1801403050 | Safe Haven Personal Care Home | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 10875 Abercorn St Apt 132, Savannah, GA 31419-1843 | 2020-09-30 |
| 1659987931 | Pinkies Place | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 216 Self St, Warner Robins, GA 31088-5506 | 2020-09-22 |
| 1629680293 | Caregiver Ga, LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 3736 Executive Center Dr Ste B, Augusta, GA 30907-2360 | 2020-08-17 |
| 1730799073 | Victory Won Counseling and Res Care Prof. Corp | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 5014 Snapfinger Woods Dr, Decatur, GA 30035-4003 | 2020-08-02 |
| 1811528649 | Unison Behavioral Health | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 211 North Street, Douglas, GA 31533 | 2020-01-30 |
| 1619519709 | Gateway Behavioral Health Services | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 516 Freedom Trl, Brunswick, GA 31525-4712 | 2019-10-10 |
| 1215581756 | Elegant Lm Management, LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1020 Meadowsong Circle, Lawrenceville, GA 30043 | 2019-08-01 |
| 1467013821 | Csb of East Central Ga | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 5101 Parnell Way, Martinez, GA 30907-8896 | 2019-06-26 |
| 1013474915 | Community Service Board of East Central Georgia | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1715 Lawerence Rd, Hephzibah, GA 30815-4445 | 2019-02-27 |
| Find all providers with the same taxonomy | ||||
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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.