Provider Demographics
NPI:1932405677
Name:M.C. LIBRARY EDUCATION CENTER CORP
Entity Type:Organization
Organization Name:M.C. LIBRARY EDUCATION CENTER CORP
Other - Org Name:MCLECC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CLEBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MERAT
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:678-508-1068
Mailing Address - Street 1:2520 PARK CENTRAL BLVD STE C2
Mailing Address - Street 2:P . O . BOX 322 DOUGLASVILLE GA 301333
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30035-3924
Mailing Address - Country:US
Mailing Address - Phone:678-508-1068
Mailing Address - Fax:678-248-1716
Practice Address - Street 1:2520 PARK CENTRAL BLVD STE C2
Practice Address - Street 2:322 P O BOX DOUGLASVILLE GA 301333
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30035-3924
Practice Address - Country:US
Practice Address - Phone:678-508-1068
Practice Address - Fax:678-248-1716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-27
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251C00000X
FL251T00000X, 251V00000X, 320700000X
GA251V00000X, 305R00000X, 3104A0630X, 320900000X, 347E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
No251V00000XAgenciesVoluntary or Charitable
No305R00000XManaged Care OrganizationsPreferred Provider Organization
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
No347E00000XTransportation ServicesTransportation Broker
Provider Identifiers
StateIdentifier IDID TypeIssuer
0Other0
GA=========Medicaid
FL=========Medicaid