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General NPI Number Information
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NPI Number | 1275892523
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Entity Type | Organization
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Legal Business Name | STATE OF ALABAMA
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Dates
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Enumeration Date | 05/08/2012
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Last Update Date | 05/08/2012
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Provider Practice Location Address
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Address Line | 200 UNIVERSITY BLVD
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City | TUSCALOOSA
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State | AL
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Zip | 35401-1250
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Country | US
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Telephone | 205-759-0682
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Fax |
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Provider Business Mailing Address
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Address Line | 2406 DEER HAVEN DR
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City | NORTHPORT
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State | AL
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Zip | 35473-3051
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Country | US
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Telephone | 205-331-4747
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Fax |
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Authorized Official
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Title or Position | RN
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Name | MRS. MALISSIA WARD
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Credential |
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Telephone | 205-331-4747
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number | 1-123265
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License Number State | AL
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