Healthcare Provider Details

I. General information

NPI: 1366773160
Provider Name (Legal Business Name): DEBRICK, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2010
Last Update Date: 01/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 6TH ST 1701 MONTROSE DRIVE
TUSCALOOSA AL
35401-1705
US

IV. Provider business mailing address

2727 6TH STREET P. O. BOX 2442
TUSCALOOSA AL
35403
US

V. Phone/Fax

Practice location:
  • Phone: 205-246-1592
  • Fax: 205-752-9026
Mailing address:
  • Phone: 205-246-1592
  • Fax: 205-752-9026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number StateAL

VIII. Authorized Official

Name: MRS. DEBBIE MOORE JENKINS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 205-246-1592