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General NPI Number Information
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NPI Number | 1700982840
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Entity Type | Organization
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Legal Business Name | CHILDREN'S PROTECTIVE ASSOCIATE INCORPORATE
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Dates
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Enumeration Date | 09/16/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1309 UPPER WETUMPKA RD 1309 UPPER WETUMPKA RD.
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City | MONTGOMERY
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State | AL
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Zip | 36107-1217
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Country | US
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Telephone | 334-265-0784
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Fax | 334-265-9701
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Provider Business Mailing Address
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Address Line | 1309 UPPER WETUMPKA RD 1309 UPPER WETUMPKA RD.
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City | MONTGOMERY
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State | AL
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Zip | 36107-1217
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Country | US
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Telephone | 334-265-0784
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Fax | 334-265-9701
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. KIMBERLY ANN HERBERT
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Credential |
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Telephone | 334-590-8568
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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 | 298
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License Number State | AL
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