Provider Demographics
NPI:1043231525
Name:DALE COUNTY RESCUE AND RECOVERY
Entity Type:Organization
Organization Name:DALE COUNTY RESCUE AND RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACKMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-333-3826
Mailing Address - Street 1:PO BOX 145
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:AL
Mailing Address - Zip Code:36352-0145
Mailing Address - Country:US
Mailing Address - Phone:334-299-0222
Mailing Address - Fax:334-299-3174
Practice Address - Street 1:449 S COLLEGE ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:AL
Practice Address - Zip Code:36352-4018
Practice Address - Country:US
Practice Address - Phone:334-299-0222
Practice Address - Fax:334-299-3174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1983416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051552962Medicaid
AL051552962Medicaid
ALW34871Medicare UPIN