MENTAL RETARDATION WAIVER PROGRAM (NPI# 1740475805) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1740475805 |
| Entity Type | Organization |
| Organization Name | MENTAL RETARDATION WAIVER PROGRAM |
| Practice Address |
2100 Comer Ave Columbus GA 31904-8725 |
| Practice Telephone | 7065965583 |
| Practice Fax Number | 7065965589 |
| Mailing Telephone | 7065965583 |
| Mailing Fax Number | 7065965589 |
| Enumeration Date | 2007-09-12 |
| Last Update Date | 2007-09-12 |
| Authorized Official Name | PERRY ALEXANDER (CEO) |
| Authorized Official Telephone | 7065965582 |
| Is Organization Subpart | Y |
| Parent Organization Name | NEW HORIZONS COMMUNITY SERVICE BOARD |
| 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 |
|---|---|---|---|---|
| 1467647875 | Mental Retardation Waiver Program | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 119 Claborn St., Cuthbert, GA 39840 | 2007-09-10 |
| Street Address |
2100 COMER AVE |
| City | COLUMBUS |
| State | GA |
| Zip Code | 31904-8725 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164420220 | Demetria Barnes Hendrix | Pharmacist | 2100 Comer Ave, Ambulatory Care Pharmacy, Columbus, GA 31904-8725 | 2005-07-12 |
| 1801497193 | Jacqueline Jordan | Clinic/Center | 2100 Comer Ave, Columbus, GA 31904-8725 | 2020-11-04 |
| 1033725288 | Cassandra Faye Harris | Case Management | 2100 Comer Ave, Columbus, GA 31904-8725 | 2020-09-22 |
| 1245846831 | Morgan Ashley Harris | Counselor | 2100 Comer Ave, Columbus, GA 31904-8725 | 2020-09-18 |
| 1164035382 | Genoa Healthcare, LLC | Durable Medical Equipment & Medical Supplies | 2100 Comer Ave, Columbus, GA 31904-8725 | 2020-08-27 |
| 1386256097 | Diana Lynn Ezell | Counselor | 2100 Comer Ave, Columbus, GA 31904-8725 | 2020-08-24 |
| 1245840750 | Samantha Meghan Bruffy | Registered Nurse | 2100 Comer Ave, Columbus, GA 31904-8725 | 2020-08-10 |
| 1083222871 | Paulette Davis | Licensed Practical Nurse | 2100 Comer Ave, Columbus, GA 31904-8725 | 2020-07-17 |
| 1245859859 | Ryan James Aker | Case Manager/Care Coordinator | 2100 Comer Ave, Columbus, GA 31904-8725 | 2020-04-14 |
| 1477188035 | Samantha Marie Dent | Case Manager/Care Coordinator | 2100 Comer Ave, Columbus, GA 31904-8725 | 2020-03-04 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821641457 | At Home Palliative Care, LLC | Nursing Care | 114 Enterprise Ct, Suite B, Columbus, GA 31904 | 2019-07-23 |
| 1285191049 | Shandra Ladell Grimes | Nurse Practitioner | 2300 Manchester Expwy St Francis Hospital, Suite C-001, Columbus, GA 31904 | 2019-02-27 |
| 1881161529 | Lesley Kathleen Simmons | Massage Therapist | 5402 15th Ave, Columbus, GA 31904 | 2018-10-31 |
| 1184190662 | Alphonsa Joseph | Nurse Practitioner | 2430 Brookstone Centre Parkway, Columbus, Georgia 31904, Columbus, GA 31904 | 2018-10-22 |
| 1568942704 | William Pearce Massey | Social Worker | 8851-1 Moore Road, Columbus, GA 31904 | 2018-08-17 |
| 1033696372 | Marlise V. Gray | Counselor | 2013 Devonshire Dr. Suite 115, Columbus, GA 31904 | 2018-07-19 |
| 1710418173 | Amanda Barnette Pruett | Behavioral Analyst | 200 Brookstone Centre Pkwy Bldg 200, Columbus, GA 31904 | 2017-03-27 |
| 1750833232 | Carrie Leigh Whitehead | Nurse Practitioner | 6228 Bradley Park Dr. Suite A, Columbus, GA 31904 | 2016-10-31 |
| 1609323369 | Shomika Lasha Battle | Registered Nurse | 2101 North Avenue, Columbus, GA 31904 | 2016-09-09 |
| 1952759219 | Peaceful River Home Care Agency | In Home Supportive Care | 738 Rudgate Road, Columbus, GA 31904 | 2016-05-27 |
| Find all providers in zip 31904 | ||||
| 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 |
|---|---|---|---|---|
| 1629680418 | Catapillars To Butterflies, LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 5900 Sharon Woods Blvd Ste D, Columbus, OH 43229-2600 | 2020-08-21 |
| 1720559420 | Secure Haven Care, LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 4295 Braunton Rd, Columbus, OH 43220-4301 | 2018-12-06 |
| 1851882617 | Cg-hhc, LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 200 Civic Center Dr Ste 1200, Columbus, OH 43215-4234 | 2018-05-28 |
| 1659882256 | Heinzerling Foundation | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1605 Heinzerling Drive, Columbus, OH 43223 | 2017-10-23 |
| 1679084271 | Heinzerling Foundation | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1625 Heinzerling Drive, Columbus, OH 43223 | 2017-10-23 |
| 1902286693 | Advoserv of New Jersey, Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1182 Hedding Rd, Columbus, NJ 08022 | 2015-06-08 |
| 1356658918 | Jireh Services, Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 3509 Refugee Rd, Columbus, OH 43232-4830 | 2010-09-02 |
| 1902077258 | Viaquest Healthcare Central | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 5314 Redwood Rd, Columbus, OH 43229-4441 | 2008-03-14 |
| 1750576807 | Mental Retardation Waiver Program Muscogee | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 2401 Buena Vista Rd, Columbus, GA 31906-3142 | 2007-09-12 |
| 1851507180 | Heinzerling Developmental Center | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1755 Heinzerling Dr, Columbus, OH 43223-3672 | 2007-05-15 |
| Find all providers in COLUMBUS | ||||
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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.