Healthcare Provider Details

I. General information

NPI: 1790838233
Provider Name (Legal Business Name): CHATTAHOOCHEE VALLEY AREA ASSOCIATION FOR RETARDED CITIZENS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6345 FAIRFAX BYP
VALLEY AL
36854-4558
US

IV. Provider business mailing address

PO BOX 416
VALLEY AL
36854-0416
US

V. Phone/Fax

Practice location:
  • Phone: 334-756-2868
  • Fax: 334-756-7801
Mailing address:
  • Phone: 334-756-2868
  • Fax: 334-756-7801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. TONY EDMONDSON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 334-756-7801