Provider Demographics
NPI:1568754737
Name:CARE NETWORK OF EAST ALABAMA, INC.
Entity Type:Organization
Organization Name:CARE NETWORK OF EAST ALABAMA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE CHAIRMAN OF THE BOARD
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:LISENBY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-528-5981
Mailing Address - Street 1:1365 GATEWOOD DR
Mailing Address - Street 2:SUITE 521
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-2834
Mailing Address - Country:US
Mailing Address - Phone:334-528-5867
Mailing Address - Fax:334-528-1195
Practice Address - Street 1:1365 GATEWOOD DR
Practice Address - Street 2:SUITE 521
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-2834
Practice Address - Country:US
Practice Address - Phone:334-528-5867
Practice Address - Fax:334-528-1195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-06
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL999OtherMISCELLANEOUS PROVIDER