Basic Information
| Provider Information | |||||||||
| NPI: | 1871655878 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RIVER EDGE BEHAVIORAL HEALTH CENTER | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | OVERLOOK 2 | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1400 GRAY HWY | ||||||||
| Address2: | APT. 109 | ||||||||
| City: | MACON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 312111901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4787514519 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1400 GRAY HWY | ||||||||
| Address2: | APT. 109 | ||||||||
| City: | MACON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 312111901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4787514519 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/15/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | TYLER | ||||||||
| AuthorizedOfficialFirstName: | EMILY | ||||||||
| AuthorizedOfficialMiddleName: | BETH | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 4787523231 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | GA | Y | Agencies | Community/Behavioral Health |
No ID Information.