Provider Demographics
NPI:1255401162
Name:PUTNAM-JASPER ASSOC. FOR MENTALLY HANDICAPPED, INC.
Entity type:Organization
Organization Name:PUTNAM-JASPER ASSOC. FOR MENTALLY HANDICAPPED, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:N
Authorized Official - Last Name:COPELAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-485-8391
Mailing Address - Street 1:PO BOX 3115
Mailing Address - Street 2:
Mailing Address - City:EATONTON
Mailing Address - State:GA
Mailing Address - Zip Code:31024-3115
Mailing Address - Country:US
Mailing Address - Phone:706-485-8391
Mailing Address - Fax:706-485-0066
Practice Address - Street 1:149 SARA LEE DRIVE
Practice Address - Street 2:
Practice Address - City:EATONTON
Practice Address - State:GA
Practice Address - Zip Code:31024-3115
Practice Address - Country:US
Practice Address - Phone:706-485-8391
Practice Address - Fax:706-485-0066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAH202329251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services