Healthcare Provider Details

I. General information

NPI: 1346393519
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: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2129 E SOUTH BLVD
MONTGOMERY AL
36116-2409
US

IV. Provider business mailing address

2129 E SOUTH BLVD
MONTGOMERY AL
36116-2409
US

V. Phone/Fax

Practice location:
  • Phone: 334-613-2200
  • Fax: 334-619-1973
Mailing address:
  • Phone: 334-613-2200
  • Fax: 334-619-1973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. RUSSELL STEVEN SHIVERS
Title or Position: COMMISSIONER
Credential:
Phone: 334-613-2200