Provider Demographics
NPI:1083717730
Name:MARSHALL JACKSON MENTAL RETARDATION AUTHORITY, INC.
Entity Type:Organization
Organization Name:MARSHALL JACKSON MENTAL RETARDATION AUTHORITY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:S
Authorized Official - Last Name:DOBBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-582-7528
Mailing Address - Street 1:2024 GUNTER AVE
Mailing Address - Street 2:
Mailing Address - City:GUNTERSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35976-2113
Mailing Address - Country:US
Mailing Address - Phone:256-582-7528
Mailing Address - Fax:256-582-7311
Practice Address - Street 1:2024 GUNTER AVE
Practice Address - Street 2:
Practice Address - City:GUNTERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35976-2113
Practice Address - Country:US
Practice Address - Phone:256-582-7528
Practice Address - Fax:256-582-7311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251B00000XAgenciesCase Management
Not Answered251C00000XAgenciesDay Training, Developmentally Disabled Services