Provider Demographics
NPI:1629792700
Name:A DISTINGUISHED WOMAN OF ALABAMA
Entity Type:Organization
Organization Name:A DISTINGUISHED WOMAN OF ALABAMA
Other - Org Name:A DISTINGUISHED WOMAN OF ALABAMA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SABRIANA
Authorized Official - Middle Name:SWAIN
Authorized Official - Last Name:ADEKUNLE
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:205-233-4979
Mailing Address - Street 1:1003 COOSA ST W
Mailing Address - Street 2:
Mailing Address - City:TALLADEGA
Mailing Address - State:AL
Mailing Address - Zip Code:35160-1880
Mailing Address - Country:US
Mailing Address - Phone:205-233-4979
Mailing Address - Fax:
Practice Address - Street 1:1003 COOSA ST W
Practice Address - Street 2:
Practice Address - City:TALLADEGA
Practice Address - State:AL
Practice Address - Zip Code:35160-1880
Practice Address - Country:US
Practice Address - Phone:205-612-5244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-03
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
No251J00000XAgenciesNursing CareGroup - Multi-Specialty