Healthcare Provider Details

I. General information

NPI: 1073653432
Provider Name (Legal Business Name): MOBILE ASSOCIATION FOR RETARDED CITIZENS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 08/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2424 GORDON SMITH DR
MOBILE AL
36617-2319
US

IV. Provider business mailing address

2424 GORDON SMITH DR
MOBILE AL
36617-2319
US

V. Phone/Fax

Practice location:
  • Phone: 251-479-7409
  • Fax: 251-473-7649
Mailing address:
  • Phone: 251-479-7409
  • Fax: 251-473-7649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateAL
# 4
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateAL
# 5
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number StateAL

VIII. Authorized Official

Name: MR. JEFF ZOGHBY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 251-665-9626