Healthcare Provider Details

I. General information

NPI: 1518638600
Provider Name (Legal Business Name): EASTER SEALS ALABAMA, INC. EASTER SEALS WEST ALABAMA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2021
Last Update Date: 09/28/2021
Certification Date: 09/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 JAMES I HARRISON JR PKWY E STE 200
TUSCALOOSA AL
35405-2662
US

IV. Provider business mailing address

PO BOX 2817
TUSCALOOSA AL
35403-2817
US

V. Phone/Fax

Practice location:
  • Phone: 205-759-1211
  • Fax: 205-349-1162
Mailing address:
  • Phone: 205-759-1211
  • Fax: 205-349-1162

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. RONNY B JOHNSTON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 205-759-1211