Mental Retardation Waiver Program

NPI #1467647875 in Cuthbert, Georgia

Provider Information

NPI Number: 1467647875
Entity Type: Organization
Organization Name: Mental Retardation Waiver Program
Primary Specialty: Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Enumeration Date: Sep 10, 2007
Last Updated: Sep 13, 2007

Practice Location

Address: 119 CLABORN ST.
City: Cuthbert
State: Georgia
ZIP Code: 39840
Phone: (706) 596-5583

Authorized Official

Name: PERRY ALEXANDER
Title: CEO
Phone: (706) 596-5582

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities	320900000X	Primary

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