Organization
MENTAL RETARDATION WAIVER PROGRAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PERRY ALEXANDER (CEO)
(706) 596-5582
Entity
Organization
Contact information
Practice address
119 CLABORN ST., CUTHBERT, GA 39840
(706) 596-5583
Mailing address
2100 COMER AVE, COLUMBUS, GA 31904-8725
(706) 321-9606
(706) 322-6576
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
09/10/2007
Last updated
09/13/2007
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