Provider Demographics
NPI:1578730602
Name:AUTAUGA WESTERN ELMORE ARC
Entity Type:Organization
Organization Name:AUTAUGA WESTERN ELMORE ARC
Other - Org Name:AUTAUGA WESTERN ELMORE ASSOCIATION FOR RETARDED CITIZENS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BYRNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-365-4054
Mailing Address - Street 1:298 JAY ST
Mailing Address - Street 2:
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36066-6062
Mailing Address - Country:US
Mailing Address - Phone:334-361-6008
Mailing Address - Fax:334-491-0500
Practice Address - Street 1:298 JAY ST
Practice Address - Street 2:
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36066-6062
Practice Address - Country:US
Practice Address - Phone:334-361-6008
Practice Address - Fax:334-491-0500
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AUTAUGA WESTERN ELMORE ASSOCIATION FOR RETARDED CITIZENS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529929810Medicaid