Provider Demographics
NPI:1992843346
Name:PEACH COUNTY ASSOCIATION FOR THE M.R. INC
Entity Type:Organization
Organization Name:PEACH COUNTY ASSOCIATION FOR THE M.R. INC
Other - Org Name:KAY COMMUNITY SERVICE CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:YOUNGBLOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-825-3124
Mailing Address - Street 1:213 ALLEN ST
Mailing Address - Street 2:
Mailing Address - City:FORT VALLEY
Mailing Address - State:GA
Mailing Address - Zip Code:31030-2714
Mailing Address - Country:US
Mailing Address - Phone:478-825-3124
Mailing Address - Fax:478-825-8054
Practice Address - Street 1:213 ALLEN ST
Practice Address - Street 2:
Practice Address - City:FORT VALLEY
Practice Address - State:GA
Practice Address - Zip Code:31030-2714
Practice Address - Country:US
Practice Address - Phone:478-825-3124
Practice Address - Fax:478-825-8054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services