MENTAL RETARDATION WAIVER PROGRAM (NPI# 1467647875) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1467647875 |
Entity Type | Organization |
Organization Name | MENTAL RETARDATION WAIVER PROGRAM |
Practice Address |
119 Claborn St. Cuthbert GA 39840 |
Mailing Address |
2100 Comer Ave Columbus GA 31904-8725 |
Practice Telephone | 7065965583 |
Mailing Telephone | 7063219606 |
Mailing Fax Number | 7063226576 |
Enumeration Date | 2007-09-10 |
Last Update Date | 2007-09-13 |
Authorized Official Name | PERRY ALEXANDER (CEO) |
Authorized Official Telephone | 7065965582 |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 320900000X | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | Residential Treatment Facilities |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1740475805 | Mental Retardation Waiver Program | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 2100 Comer Ave, Columbus, GA 31904-8725 | 2007-09-12 |
Street Address |
119 CLABORN ST. |
City | CUTHBERT |
State | GA |
Zip Code | 39840 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1366867533 | Rashema Vandetta Warren | Case Manager/Care Coordinator | 90 Villa Nova Street, New Horizons, Cuthbert, GA 39840 | 2014-02-25 |
1417378415 | Temperess Johnson | Adult Companion | 72 Cleborne Street, Cuthbert, GA 39840 | 2013-12-18 |
1730500976 | Mary Gibbs | Case Manager/Care Coordinator | 72 Clebourne Street, Cuthbert, GA 39840 | 2013-12-13 |
1023448917 | Katie Wright | Counselor | 72 Clebourne St, Cuthbert, GA 39840 | 2013-11-14 |
1588952048 | Michael Carr Jr. | Dentist | 84 Court Street, Cuthbert, GA 39840 | 2011-07-19 |
1518286764 | Lisa Ann Hardwick | Occupational Therapy Assistant | 2058 Hghway 82, Cuthbuert, GA 39840 | 2010-05-27 |
1952630154 | Naomi S Jenkins | Counselor | 264 Lumpkin Street, Cuthbert, GA 39840 | 2009-12-17 |
1376614073 | Randolph County Coutny School System | Local Education Agency (LEA) | 3451 Ga Hwy 266, Cuthbert, GA 39840 | 2006-11-13 |
1437632890 | Gary Nell Glover | Community Health Worker | 72 Clebourne Street, Cuthbert, GA 39840 | 2018-09-12 |
1235547456 | Cynthia Gibson | Community Health Worker | 72 Clebourne Street, Cuthbert, GA 39840 | 2014-07-31 |
Find all providers in zip 39840 |
Taxonomy Code | 320900000X |
Grouping | Residential Treatment Facilities |
Classification | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. |
Notes: [7/1/2003: new] |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1790385862 | Hickory Log Vocational School Inc | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 3680 Highway 411 Ne, White, GA 30184-2427 | 2020-10-28 |
1801403050 | Safe Haven Personal Care Home | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 10875 Abercorn St Apt 132, Savannah, GA 31419-1843 | 2020-09-30 |
1659987931 | Pinkies Place | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 216 Self St, Warner Robins, GA 31088-5506 | 2020-09-22 |
1629680293 | Caregiver Ga, LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 3736 Executive Center Dr Ste B, Augusta, GA 30907-2360 | 2020-08-17 |
1730799073 | Victory Won Counseling and Res Care Prof. Corp | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 5014 Snapfinger Woods Dr, Decatur, GA 30035-4003 | 2020-08-02 |
1811528649 | Unison Behavioral Health | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 211 North Street, Douglas, GA 31533 | 2020-01-30 |
1619519709 | Gateway Behavioral Health Services | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 516 Freedom Trl, Brunswick, GA 31525-4712 | 2019-10-10 |
1215581756 | Elegant Lm Management, LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1020 Meadowsong Circle, Lawrenceville, GA 30043 | 2019-08-01 |
1467013821 | Csb of East Central Ga | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 5101 Parnell Way, Martinez, GA 30907-8896 | 2019-06-26 |
1013474915 | Community Service Board of East Central Georgia | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1715 Lawerence Rd, Hephzibah, GA 30815-4445 | 2019-02-27 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.