MEDICARE: JEFFERSON COUNTY COMMITTEE FOR ECONOMIC OPPORTUNITY

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	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1568541787
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEFFERSON COUNTY COMMITTEE FOR ECONOMIC OPPORTUNITY

Provider Business Mailing Address
First Line	:	300 8TH AVE W
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35204-3039
Country	:	US
Telephone Number	:	205-327-7500
Fax Number	:	205-326-4179

Provider Business Practice Location Address
First Line	:	228 2ND AVE N
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35204-4709
Country	:	US
Telephone Number	:	205-787-3040
Fax Number	:	205-783-6542

Authorized Official
Title or Position	:	PROGRAM CLINICAL COORDINATOR
Name	:	MS. LYNNEICE WILLIAMS
Credential	:	MSW
Telephone Number	:	205-787-3040

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	08/22/2020

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