NPI 1083809040

Mental Retardation Wavier Program

Organisation Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility Columbus, GA

Practice location

Address: 2100 Comer Ave., Columbus, GA 31904
Phone: (706) 596-5583
Fax: (706) 596-5589
Mailing address: 1325 Sandusky Dr, Columbus, GA 31907-3964

Authorised official

Name: Perry Alexander
Title: Ceo
Phone: (706) 596-5582

Registered specialties

Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility Primary

Residential Treatment Facilities Taxonomy 320900000X

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Registry record

NPI: 1083809040
Entity type: Organization
NPI issued: 12 Sep 2007
Record last updated: 12 Sep 2007

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.