Provider Demographics
NPI:1245604941
Name:WARREN COUNTY ASSN.FOR RETARDED CITIZENS, INC.
Entity Type:Organization
Organization Name:WARREN COUNTY ASSN.FOR RETARDED CITIZENS, INC.
Other - Org Name:MIDD WEST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KEARNEY
Authorized Official - Middle Name:B
Authorized Official - Last Name:WAITES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-638-2761
Mailing Address - Street 1:100 SMOKEY LANE
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39180
Mailing Address - Country:US
Mailing Address - Phone:601-638-2761
Mailing Address - Fax:601-638-2733
Practice Address - Street 1:100 SMOKEY LANE
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39180
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:2015-11-18
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSMIDD-AGENCY251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services