Healthcare Provider Details

I. General information

NPI: 1376699116
Provider Name (Legal Business Name): COMMUNITY SERVICE PROGRAMS OF WEST AL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 04/30/2008
Certification Date:
Deactivation Date: 02/14/2007
Reactivation Date: 04/30/2008

III. Provider practice location address

2002 MCFARLAND BLVD E SUITE 209
TUSCALOOSA AL
35404
US

IV. Provider business mailing address

601 17TH STREET
TUSCALOOSA AL
35401-6311
US

V. Phone/Fax

Practice location:
  • Phone: 205-752-0476
  • Fax: 205-752-8122
Mailing address:
  • Phone: 205-752-0476
  • Fax: 205-752-8122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MARY BETH VICK
Title or Position: SUPERVISOR
Credential:
Phone: 205-752-0476