Provider Demographics
NPI:1457094187
Name:CENTRAL ALABAMA AGING CONSORTIUM
Entity Type:Organization
Organization Name:CENTRAL ALABAMA AGING CONSORTIUM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:SEGREST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-240-4668
Mailing Address - Street 1:2500 FAIRLANE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116-1651
Mailing Address - Country:US
Mailing Address - Phone:334-240-4680
Mailing Address - Fax:334-240-4681
Practice Address - Street 1:2500 FAIRLANE DR STE 200
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-1651
Practice Address - Country:US
Practice Address - Phone:334-240-4680
Practice Address - Fax:334-240-4681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management