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General NPI Number Information
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NPI Number | 1336137488
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Entity Type | Organization
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Legal Business Name | FATHER WALTER MEMORIAL CHILD CARE CENTER
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Dates
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Enumeration Date | 10/12/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2815 FORBES DR
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City | MONTGOMERY
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State | AL
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Zip | 36110-1307
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Country | US
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Telephone | 334-262-6421
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Fax | 334-262-2265
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Provider Business Mailing Address
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Address Line | 2815 FORBES DR
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City | MONTGOMERY
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State | AL
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Zip | 36110-1307
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Country | US
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Telephone | 334-262-6421
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Fax | 334-262-2265
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Authorized Official
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Title or Position | DIRECTOR OF NURSING
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Name | MISS YATAISHA FELEESE ROBERTSON
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Credential | RN
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Telephone | 334-230-1935
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3140N1450X
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Taxonomy Name | Pediatric Skilled Nursing Facility
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License Number | 08394
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License Number State | AL
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