Healthcare Provider Details

I. General information

NPI: 1629792700
Provider Name (Legal Business Name): A DISTINGUISHED WOMAN OF ALABAMA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2022
Last Update Date: 07/11/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 COOSA ST W
TALLADEGA AL
35160-1880
US

IV. Provider business mailing address

1003 COOSA ST W
TALLADEGA AL
35160-1880
US

V. Phone/Fax

Practice location:
  • Phone: 205-612-5244
  • Fax:
Mailing address:
  • Phone: 205-233-4979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. SABRIANA SWAIN ADEKUNLE
Title or Position: CEO
Credential: BS
Phone: 205-233-4979