Provider Demographics
NPI:1558683409
Name:SOUTH ALABAMA LEISURE REHABILITATION RECREATION CENTER INC
Entity Type:Organization
Organization Name:SOUTH ALABAMA LEISURE REHABILITATION RECREATION CENTER INC
Other - Org Name:SALRRCI
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER / CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MACKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-824-4689
Mailing Address - Street 1:8571 THREE MILE RD
Mailing Address - Street 2:LOT 4
Mailing Address - City:IRVINGTON
Mailing Address - State:AL
Mailing Address - Zip Code:36544-3301
Mailing Address - Country:US
Mailing Address - Phone:251-824-1441
Mailing Address - Fax:251-824-1675
Practice Address - Street 1:8571 THREE MILE RD
Practice Address - Street 2:LOT 4
Practice Address - City:IRVINGTON
Practice Address - State:AL
Practice Address - Zip Code:36544-3301
Practice Address - Country:US
Practice Address - Phone:251-824-1441
Practice Address - Fax:251-824-1675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-19
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services