Provider Demographics
NPI:1790838233
Name:CHATTAHOOCHEE VALLEY AREA ASSOCIATION FOR RETARDED CITIZENS
Entity Type:Organization
Organization Name:CHATTAHOOCHEE VALLEY AREA ASSOCIATION FOR RETARDED CITIZENS
Other - Org Name:VALLEY HAVEN SCHOOL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:EDMONDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-756-7801
Mailing Address - Street 1:PO BOX 416
Mailing Address - Street 2:
Mailing Address - City:VALLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36854-0416
Mailing Address - Country:US
Mailing Address - Phone:334-756-2868
Mailing Address - Fax:334-756-7801
Practice Address - Street 1:6345 FAIRFAX BYP
Practice Address - Street 2:
Practice Address - City:VALLEY
Practice Address - State:AL
Practice Address - Zip Code:36854-4558
Practice Address - Country:US
Practice Address - Phone:334-756-2868
Practice Address - Fax:334-756-7801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services