1861742611 NPI number — ALABAMA AUTISM ASSISTANCE PROGRAM

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861742611 NPI number — ALABAMA AUTISM ASSISTANCE PROGRAM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALABAMA AUTISM ASSISTANCE PROGRAM
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:
6
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:
1861742611
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 SHADOW WOOD PARK STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35244-3411
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-733-0976
Provider Business Mailing Address Fax Number:
205-733-0977

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 SHADOW WOOD PARK STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35244-3411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-733-0976
Provider Business Practice Location Address Fax Number:
205-733-0977
Provider Enumeration Date:
09/19/2012

Additional Information

Authorized Official

Authorized Official Last Name:
KING
Authorized Official First Name:
COURTNEY
Authorized Official Middle Name:
DEES
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
205-733-0976

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , with the licence number:  1041480 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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