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General NPI Number Information
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NPI Number | 1548595929
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Entity Type | Organization
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Legal Business Name | AMAZING GRACE
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Dates
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Enumeration Date | 10/02/2009
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Last Update Date | 10/02/2009
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Provider Practice Location Address
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Address Line | 3016 PINECREST RD
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City | TUSCALOOSA
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State | AL
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Zip | 35404-1324
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Country | US
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Telephone | 205-887-0888
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Fax | 205-633-3644
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Provider Business Mailing Address
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Address Line | 3521 ARCADIA DR
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City | TUSCALOOSA
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State | AL
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Zip | 35404-4370
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Country | US
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Telephone | 205-633-3635
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Fax | 205-633-3635
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Authorized Official
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Title or Position | DIRECTOR/OWNER
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Name | GLORIA B SYLVESTER
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Credential |
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Telephone | 205-887-0888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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