Healthcare Provider Details

I. General information

NPI: 1437202603
Provider Name (Legal Business Name): ALABAMA DEPARTMENT OF REHABILITATION SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 01/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 S LAWRENCE ST
MONTGOMERY AL
36104-4787
US

IV. Provider business mailing address

602 S LAWRENCE ST
MONTGOMERY AL
36104-4787
US

V. Phone/Fax

Practice location:
  • Phone: 334-293-7500
  • Fax: 334-293-7373
Mailing address:
  • Phone: 334-293-7500
  • Fax: 334-293-7373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MR. CARY BOSWELL
Title or Position: COMMISSIONER
Credential:
Phone: 334-293-7500