MEDICARE: FATHER WALTER MEMORIAL CHILD CARE CENTER

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	3140N1450X	Pediatric Skilled Nursing Facility	08394	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336137488
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FATHER WALTER MEMORIAL CHILD CARE CENTER

Provider Business Mailing Address
First Line	:	2815 FORBES DR
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36110-1307
Country	:	US
Telephone Number	:	334-262-6421
Fax Number	:	334-262-2265

Provider Business Practice Location Address
First Line	:	2815 FORBES DR
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36110-1307
Country	:	US
Telephone Number	:	334-262-6421
Fax Number	:	334-262-2265

Authorized Official
Title or Position	:	DIRECTOR OF NURSING
Name	:	MISS YATAISHA FELEESE ROBERTSON
Credential	:	RN
Telephone Number	:	334-230-1935

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	08/22/2020

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