Healthcare Provider Details

I. General information

NPI: 1982850491
Provider Name (Legal Business Name): NORTH CENTRAL ALABAMA MENTAL RETARDATION AUTHORITY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2008
Last Update Date: 08/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 MOULTON ST E
DECATUR AL
35601-3000
US

IV. Provider business mailing address

445 MOULTON ST E P.O. BOX 597
DECATUR AL
35601-3000
US

V. Phone/Fax

Practice location:
  • Phone: 256-355-7315
  • Fax: 256-355-7315
Mailing address:
  • Phone: 256-355-7315
  • Fax: 256-355-7315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. EARL E. BRIGHTWELL
Title or Position: DIRECTOR
Credential:
Phone: 256-355-7315