1306942628 NPI number — MOBILE FAMILY CARE CENTER,INC

Table of content: KASSIDI RENEE JORDAN LMSW (NPI 1962159731)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306942628 NPI number — MOBILE FAMILY CARE CENTER,INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOBILE FAMILY CARE CENTER,INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306942628
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 190145
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOBILE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36619
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-666-3737
Provider Business Mailing Address Fax Number:
251-666-3733

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5560 NEVIUS ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOBILE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36619
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-666-3737
Provider Business Practice Location Address Fax Number:
251-666-3733
Provider Enumeration Date:
09/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
COOPER
Authorized Official First Name:
LAURA
Authorized Official Middle Name:
S
Authorized Official Title or Position:
SECRETARY/TREASURER
Authorized Official Telephone Number:
251-666-3737

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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