Provider Demographics
NPI:1043335045
Name:WARREN COUNTY ASSOCIATION FOR RETARDED CITIZENS, INC
Entity type:Organization
Organization Name:WARREN COUNTY ASSOCIATION FOR RETARDED CITIZENS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR-ARC PROGRAMS
Authorized Official - Prefix:MR
Authorized Official - First Name:KEARNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WAITES
Authorized Official - Suffix:
Authorized Official - Credentials:MED LSW
Authorized Official - Phone:601-638-2761
Mailing Address - Street 1:100 SMOKY LN
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39180-5940
Mailing Address - Country:US
Mailing Address - Phone:601-638-2761
Mailing Address - Fax:601-638-2733
Practice Address - Street 1:100 SMOKY LN
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39180-5940
Practice Address - Country:US
Practice Address - Phone:601-638-2761
Practice Address - Fax:601-638-2733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00770130Medicaid