BOBBY BENNETT HOST HOME — NPI 1639495682 (Licensed & Credentialed Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities in WAYCROSS, GA)

CMS-1500 Box 24J / 33a • NPI

1639495682

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

320900000X

Licensed & Credentialed Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities

Box 32 Service Location & ZIP+4

1007 MARY ST, WAYCROSS, GA, 31503-3823

✓ 9-Digit EDI 837 ZIP+4 (31503-3823)

Practice Phone & Referral Fax

(912) 449-7111

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1639495682 (BOBBY BENNETT HOST HOME) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1639495682` (NPI-2 Organization / Facility)
Provider / Legal Name	BOBBY BENNETT HOST HOME
Plain-English Specialty	Licensed & Credentialed Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities NUCC Code: `320900000X` (Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	1007 MARY ST, WAYCROSS, GA, 31503-3823
Practice Telephone / Fax	Tel: (912) 449-7111
Administrative Mailing Address	4156 WHITE TAIL WAY, BLACKSHEAR, GA, 31516-5204
Enumeration & Last Sync	Enumerated: 2010-04-15 \| CMS Record Updated: 2010-04-15
Authorized Official	GLYNN THOMAS (CEO)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

1007 MARY ST, WAYCROSS, GA, 31503-3823

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Plain-English Taxonomy & CMS Crosswalk (320900000X)

What Does Taxonomy Code 320900000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 320900000X translates to:
"Licensed & Credentialed Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities"

CMS-1500 Medicare Specialty Crosswalk: Standard HIPAA X12N 837P / CMS-1500
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (BOBBY BENNETT HOST HOME)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`320900000X` — Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities Plain English: Licensed & Credentialed Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities	State: N/A \| License: `Verified` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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BOBBY BENNETT HOST HOME (NPI #1639495682)