Provider Demographics
NPI:1760886543
Name:LAMAR ASSOCIATION FOR RETARDED CHILDERN
Entity Type:Organization
Organization Name:LAMAR ASSOCIATION FOR RETARDED CHILDERN
Other - Org Name:DBA: PIKE LAMAR SERVICES, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXCUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MILDRED
Authorized Official - Middle Name:A
Authorized Official - Last Name:BARBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-358-0743
Mailing Address - Street 1:210 CHAFFIN ST
Mailing Address - Street 2:
Mailing Address - City:BARNESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30204-1852
Mailing Address - Country:US
Mailing Address - Phone:770-358-0743
Mailing Address - Fax:770-358-0745
Practice Address - Street 1:210 CHAFFIN ST
Practice Address - Street 2:
Practice Address - City:BARNESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30204-1852
Practice Address - Country:US
Practice Address - Phone:770-358-0743
Practice Address - Fax:770-358-0745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-22
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000881108CMedicaid
GA000881108AMedicaid
GA300003965AMedicaid