Healthcare Provider Details

I. General information

NPI: 1851566327
Provider Name (Legal Business Name): CULLMAN ALLKIDS PLUS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2008
Last Update Date: 06/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1909 COMMERCE AVE
CULLMAN AL
35055-6151
US

IV. Provider business mailing address

PO BOX 2186
CULLMAN AL
35056-2186
US

V. Phone/Fax

Practice location:
  • Phone: 256-734-4688
  • Fax: 256-736-5638
Mailing address:
  • Phone: 256-734-4688
  • Fax: 256-736-5638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1851566327
Identifier TypeOTHER
Identifier StateAL
Identifier IssuerALL KIDS PLUS

VIII. Authorized Official

Name: CHRIS VAN DYKE
Title or Position: EXECUTIVE DIRECTOR
Credential: MA
Phone: 256-734-4688