Healthcare Provider Details

I. General information

NPI: 1396367850
Provider Name (Legal Business Name): RCA FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2020
Last Update Date: 05/07/2020
Certification Date: 05/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4720 WOODMERE BLVD
MONTGOMERY AL
36106-3065
US

IV. Provider business mailing address

8345 GREENVIEW DR
JONESBORO GA
30236-4150
US

V. Phone/Fax

Practice location:
  • Phone: 334-676-3773
  • Fax: 334-460-9721
Mailing address:
  • Phone: 404-989-2867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMY ANDERSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 334-676-3773