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General NPI Number Information
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NPI Number | 1396367850
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Entity Type | Organization
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Legal Business Name | RCA FOUNDATION
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Dates
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Enumeration Date | 05/07/2020
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Last Update Date | 05/07/2020
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Provider Practice Location Address
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Address Line | 4720 WOODMERE BLVD
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City | MONTGOMERY
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State | AL
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Zip | 36106-3065
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Country | US
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Telephone | 334-676-3773
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Fax | 334-460-9721
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Provider Business Mailing Address
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Address Line | 8345 GREENVIEW DR
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City | JONESBORO
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State | GA
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Zip | 30236-4150
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Country | US
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Telephone | 404-989-2867
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | AMY ANDERSON
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Credential |
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Telephone | 334-676-3773
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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