Organization · Type 2 NPI

Mental Retardation Waiver Program

Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Columbus, GA

NPI number 1740475805 Active

Practice location

2100 Comer Ave
Columbus, GA 31904-8725

Call (706) 596-5583 Map

Fax (706) 596-5589

Specialties and licenses

TaxonomyCodeLicense
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility Primary 320900000XNone listed

Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility: A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with intellectual and/or developmental disabilities.

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About NPI 1740475805

Mental Retardation Waiver Program's National Provider Identifier is 1740475805, issued on Sep 12, 2007. The primary taxonomy on file is Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility (320900000X), and the practice location is in Columbus, GA. The record was last updated on Sep 12, 2007.