Provider Demographics
NPI:1396367850
Name:RCA FOUNDATION
Entity Type:Organization
Organization Name:RCA FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-676-3773
Mailing Address - Street 1:8345 GREENVIEW DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-4150
Mailing Address - Country:US
Mailing Address - Phone:404-989-2867
Mailing Address - Fax:
Practice Address - Street 1:4720 WOODMERE BLVD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-3065
Practice Address - Country:US
Practice Address - Phone:334-676-3773
Practice Address - Fax:334-460-9721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-07
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health