Provider Demographics
NPI:1639291545
Name:MANASOTA ASSOC. FOR RETARDED CITIZENS
Entity type:Organization
Organization Name:MANASOTA ASSOC. FOR RETARDED CITIZENS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:DOHERTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-752-2976
Mailing Address - Street 1:PO BOX 9292
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34206-9292
Mailing Address - Country:US
Mailing Address - Phone:941-752-2976
Mailing Address - Fax:941-752-1635
Practice Address - Street 1:3659 CORTEZ RD W
Practice Address - Street 2:#130
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-3153
Practice Address - Country:US
Practice Address - Phone:941-752-2976
Practice Address - Fax:941-752-1635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services