MENTAL RETARDATION WAVIER PROGRAM – NPI #1376738781
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities

A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with intellectual and/or developmental disabilities.

MENTAL RETARDATION WAVIER PROGRAM is a community based residential treatment facility located in HAMILTON, GA. NPPES has assigned the NPI number 1376738781 to MENTAL RETARDATION WAVIER PROGRAM on September 10, 2007. It is a Type-2 NPI, indicating this NPI number is associated with an organization. The primary taxonomy selected by this provider is 320900000X from the Health Care Provider Taxonomy code set, which is classified as Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities.

The NPI profile was previously updated about 19 years ago on Sep 13, 2007. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for MENTAL RETARDATION WAVIER PROGRAM below.

NPI Profile for
MENTAL RETARDATION WAVIER PROGRAM

NPI Number
1376738781
Enumeration Date

(about 19 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
MENTAL RETARDATION WAVIER PROGRAM
Primary location
9993 GA HIGHWAY 116
HAMILTON, GA 31811
Phone: (706) 596-5583 Fax: (706) 596-5589
Mailing address
2100 COMER AVE
COLUMBUS, GA 31904-8725
Phone: (706) 596-5586 Fax:
Organization Subpart
No
Authorized Official
PERRY ALEXANDER
CEO
Phone: (706) 596-5582
Updated
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
320900000X
- Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Primary)

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.