Provider Demographics
NPI:1093122533
Name:NOAHS ARK CHILD & FAMILY TREATMENT CENTER INC
Entity Type:Organization
Organization Name:NOAHS ARK CHILD & FAMILY TREATMENT CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/FOUNDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KASSANDRA
Authorized Official - Middle Name:ALEXANDRIA
Authorized Official - Last Name:BANKS-WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-536-7614
Mailing Address - Street 1:1728 5TH AVE N
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35203-2023
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1728 5TH AVE N
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35203-2023
Practice Address - Country:US
Practice Address - Phone:205-502-7278
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-16
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization