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General NPI Number Information
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NPI Number | 1427229624
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Entity Type | Organization
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Legal Business Name | BREWER PORCH CHILDREN'S CENTER
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Dates
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Enumeration Date | 03/14/2008
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Last Update Date | 06/12/2008
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Provider Practice Location Address
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Address Line | 2501 WOODLAND RD
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City | TUSCALOOSA
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State | AL
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Zip | 35404-5028
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Country | US
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Telephone | 205-348-7236
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Fax | 205-348-9368
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Provider Business Mailing Address
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Address Line | 2501 WOODLAND RD
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City | TUSCALOOSA
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State | AL
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Zip | 35404-5028
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Country | US
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Telephone | 205-348-7236
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Fax | 205-348-9368
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Authorized Official
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Title or Position | BILLING COORDINATOR
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Name | YVONNE LYNN SEGREST
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Credential |
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Telephone | 205-348-9366
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number |
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License Number State |
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