1811171614 NPI number — ALABAMA DEPARTMENT OF REHABILITATION SERVICES

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 1811171614 NPI number — ALABAMA DEPARTMENT OF REHABILITATION SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALABAMA DEPARTMENT OF REHABILITATION SERVICES
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:
1811171614
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/28/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2129 E SOUTH BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTGOMERY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36116-2409
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-613-2200
Provider Business Mailing Address Fax Number:
334-613-1973

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2129 E SOUTH BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTGOMERY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36116-2409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-613-2200
Provider Business Practice Location Address Fax Number:
334-613-1973
Provider Enumeration Date:
12/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SHIVERS
Authorized Official First Name:
RUSSELL
Authorized Official Middle Name:
STEVEN
Authorized Official Title or Position:
COMMISSIONER
Authorized Official Telephone Number:
334-613-2200

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 510-46927 . This is a "ALL-KIDS PLUS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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