Provider Demographics
NPI:1518638600
Name:EASTER SEALS ALABAMA, INC. EASTER SEALS WEST ALABAMA
Entity Type:Organization
Organization Name:EASTER SEALS ALABAMA, INC. EASTER SEALS WEST ALABAMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RONNY
Authorized Official - Middle Name:B
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-759-1211
Mailing Address - Street 1:PO BOX 2817
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35403-2817
Mailing Address - Country:US
Mailing Address - Phone:205-759-1211
Mailing Address - Fax:205-349-1162
Practice Address - Street 1:1400 JAMES I HARRISON JR PKWY E STE 200
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35405-2662
Practice Address - Country:US
Practice Address - Phone:205-759-1211
Practice Address - Fax:205-349-1162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation