Healthcare Provider Details

I. General information

NPI: 1427414424
Provider Name (Legal Business Name): WEST ALABAMA REGIONAL COMMISSION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2016
Last Update Date: 01/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 HIGHWAY 69 N
NORTHPORT AL
35473-3504
US

IV. Provider business mailing address

PO BOX 509
NORTHPORT AL
35476-0509
US

V. Phone/Fax

Practice location:
  • Phone: 205-333-2990
  • Fax: 205-333-2713
Mailing address:
  • Phone: 205-333-2990
  • Fax: 205-333-2713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: ROBERT LAKE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 205-333-2990