MEDICARE: NOAHS ARK CHILD & FAMILY TREATMENT CENTER INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	305R00000X	Preferred Provider Organization

General Provider Information

NPI Number	:	1093122533
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOAHS ARK CHILD & FAMILY TREATMENT CENTER INC

Provider Business Mailing Address
First Line	:	1728 5TH AVE N
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35203-2023
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1728 5TH AVE N
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35203-2023
Country	:	US
Telephone Number	:	205-502-7278
Fax Number	:

Authorized Official
Title or Position	:	CEO/FOUNDER
Name	:	MRS. KASSANDRA ALEXANDRIA BANKS-WATKINS
Credential	:
Telephone Number	:	678-536-7614

Provider Enumeration Date	:	07/16/2014
Last Update Date	:	04/04/2019

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