Provider Demographics
NPI:1093815987
Name:CARE CONNECT OF ALABAMA, INC.
Entity Type:Organization
Organization Name:CARE CONNECT OF ALABAMA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:FAIRCLOTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-330-3100
Mailing Address - Street 1:2702 HOSPITAL DRIVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35476
Mailing Address - Country:US
Mailing Address - Phone:205-330-3100
Mailing Address - Fax:205-330-3126
Practice Address - Street 1:2702 HOSPITAL DRIVE
Practice Address - Street 2:SUITE 201
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35476
Practice Address - Country:US
Practice Address - Phone:205-330-3100
Practice Address - Fax:205-330-3126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALK752Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER