1184893505 NPI number — STATE OF ALABAMA

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 1184893505 NPI number — STATE OF ALABAMA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STATE OF ALABAMA
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:
HOUSTON COUNTY DHR
Provider Other Organization Name Type Code:
5
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:
1184893505
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
50 N RIPLEY ST
Provider Second Line Business Mailing Address:
FAMILY SERVICES DIVISION
Provider Business Mailing Address City Name:
MONTGOMERY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36130-1001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-242-1310
Provider Business Mailing Address Fax Number:
334-242-0198

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1605 ROSS CLARK CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOTHAN
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36301-5438
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-677-0400
Provider Business Practice Location Address Fax Number:
334-671-0389
Provider Enumeration Date:
02/29/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CORLEY
Authorized Official First Name:
PARRIS
Authorized Official Middle Name:
L
Authorized Official Title or Position:
DEPUTY COMMISSIONER FISCAL & ADMIN
Authorized Official Telephone Number:
334-242-8395

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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