=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912472770
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOUSTON COUNTY ASSOCIATION FOR EXCEPTIONAL CITIZENS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/09/2018
-----------------------------------------------------
Last Update Date | 10/09/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 202 N DAVIS DR
-----------------------------------------------------
City | WARNER ROBINS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31093-3348
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 478-929-6613
-----------------------------------------------------
Fax | 478-328-7001
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 202 N DAVIS DR
-----------------------------------------------------
City | WARNER ROBINS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31093-3348
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 478-929-6613
-----------------------------------------------------
Fax | 478-328-7001
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ASSOCIATE DIRECTOR OF ADMINISTRATIO
-----------------------------------------------------
Name | MS. LETITIA CARLOTTA PEEBLES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 478-929-6613
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251C00000X
-----------------------------------------------------
Taxonomy Name | Developmentally Disabled Services Day Training Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------