Healthcare Provider Details

I. General information

NPI: 1427229624
Provider Name (Legal Business Name): BREWER PORCH CHILDREN'S CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2008
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 WOODLAND RD
TUSCALOOSA AL
35404-5028
US

IV. Provider business mailing address

2501 WOODLAND RD
TUSCALOOSA AL
35404-5028
US

V. Phone/Fax

Practice location:
  • Phone: 205-348-7236
  • Fax: 205-348-9368
Mailing address:
  • Phone: 205-348-7236
  • Fax: 205-348-9368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: YVONNE LYNN SEGREST
Title or Position: BILLING COORDINATOR
Credential:
Phone: 205-348-9366