Provider Demographics
NPI:1588726830
Name:DOUGLAS COUNTY RETARDATION ASSOCIATION, INC.
Entity type:Organization
Organization Name:DOUGLAS COUNTY RETARDATION ASSOCIATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:HAZEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:770-942-1131
Mailing Address - Street 1:PO BOX 1318
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30133-1318
Mailing Address - Country:US
Mailing Address - Phone:770-942-1131
Mailing Address - Fax:770-920-6701
Practice Address - Street 1:6497 STRICKLAND ST
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-1256
Practice Address - Country:US
Practice Address - Phone:770-942-1131
Practice Address - Fax:770-920-6701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251C00000XAgenciesDay Training, Developmentally Disabled Services
Not Answered320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities