Healthcare Provider Details

I. General information

NPI: 1194183129
Provider Name (Legal Business Name): BRYANT CENTER TECHNICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2016
Last Update Date: 02/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2003 N GIMON CIR
MOBILE AL
36605-2348
US

IV. Provider business mailing address

2003 N GIMON CIR
MOBILE AL
36605-2348
US

V. Phone/Fax

Practice location:
  • Phone: 251-463-8398
  • Fax:
Mailing address:
  • Phone: 251-463-8398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number StateAL

VIII. Authorized Official

Name: SHANARION GABRIEL GLENN
Title or Position: CNA
Credential:
Phone: 251-463-8398