MENTAL RETARDATION WAIVER PROGRAM


Address: 119 Claborn St., Cuthbert, GA 39840
Phone: 7065965583

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).

Provider Overview

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

Taxonomy

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

Other Provider IDs and Locations

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

Office Location

Street Address 119 CLABORN ST.
City CUTHBERT
State GA
Zip Code 39840

Providers in the same zip code

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
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Taxonomy Information

Taxonomy Code 320900000X
Grouping Residential Treatment Facilities
Classification Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities

Taxonomy Definition

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]

Providers in the same taxonomy and state

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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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Competitor

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City CUTHBERT
Zip Code 39840

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Dataset Information

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.

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