Provider Demographics
NPI:1598818999
Name:SOUTHWEST ALABAMA CHAPTER COALITION FOR PERSONS WITH DISABILITIES
Entity Type:Organization
Organization Name:SOUTHWEST ALABAMA CHAPTER COALITION FOR PERSONS WITH DISABILITIES
Other - Org Name:INDEPENDENT LIVING CENTER OF MOBILE
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MA PSYCHOLOGY
Authorized Official - Phone:251-460-0301
Mailing Address - Street 1:5304B OVERLOOK RD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36618-2331
Mailing Address - Country:US
Mailing Address - Phone:251-460-0301
Mailing Address - Fax:251-341-1267
Practice Address - Street 1:5304B OVERLOOK RD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36618-2331
Practice Address - Country:US
Practice Address - Phone:251-460-0301
Practice Address - Fax:251-341-1267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services