Provider Demographics
NPI:1003886235
Name:EASTER SEALS ALABAMA INC
Entity Type:Organization
Organization Name:EASTER SEALS ALABAMA INC
Other - Org Name:EASTER SEALS REHABILITATION CENTER NORTHWEST ALABAMA PART OF LBN
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:C
Authorized Official - Last Name:PRINCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-381-1110
Mailing Address - Street 1:1450 AVALON AVE
Mailing Address - Street 2:
Mailing Address - City:MUSCLE SHOALS
Mailing Address - State:AL
Mailing Address - Zip Code:35661-3110
Mailing Address - Country:US
Mailing Address - Phone:256-381-1110
Mailing Address - Fax:256-314-5105
Practice Address - Street 1:1450 AVALON AVE
Practice Address - Street 2:
Practice Address - City:MUSCLE SHOALS
Practice Address - State:AL
Practice Address - Zip Code:35661-3110
Practice Address - Country:US
Practice Address - Phone:256-381-1110
Practice Address - Fax:256-314-5105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-23
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10684251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529100380Medicaid
AL016560Medicare ID - Type UnspecifiedPROVIDER NUMBER