Provider Demographics
NPI:1447447354
Name:EDUCATION PLAYSTATION, INC.
Entity type:Organization
Organization Name:EDUCATION PLAYSTATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:MINGONE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:770-877-9105
Mailing Address - Street 1:127 SUMMER ST
Mailing Address - Street 2:
Mailing Address - City:ADAIRSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30103-2956
Mailing Address - Country:US
Mailing Address - Phone:770-877-9105
Mailing Address - Fax:770-877-9106
Practice Address - Street 1:127 SUMMER ST
Practice Address - Street 2:
Practice Address - City:ADAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30103-2956
Practice Address - Country:US
Practice Address - Phone:770-877-9105
Practice Address - Fax:770-877-9106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11-6874261QH0700X, 261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA012454464BMedicaid
GA000708463EMedicaid
GA478159310BMedicaid
GA385626610CMedicaid
GA012454464BMedicaid