Provider Demographics
NPI:1871671883
Name:NORTHEAST ALABAMA MRDD AUTHORITY
Entity Type:Organization
Organization Name:NORTHEAST ALABAMA MRDD AUTHORITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:W
Authorized Official - Last Name:CARR
Authorized Official - Suffix:
Authorized Official - Credentials:PH D
Authorized Official - Phone:256-547-4407
Mailing Address - Street 1:PO BOX 1547
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35902-1547
Mailing Address - Country:US
Mailing Address - Phone:256-547-4407
Mailing Address - Fax:256-547-4439
Practice Address - Street 1:340 S 2ND ST
Practice Address - Street 2:SUITE 8
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-5201
Practice Address - Country:US
Practice Address - Phone:256-547-4407
Practice Address - Fax:256-547-4439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251B00000XAgenciesCase Management
Not Answered251C00000XAgenciesDay Training, Developmentally Disabled Services
Not Answered320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities