Provider Demographics
NPI:1891849725
Name:ALABAMA DEPARTMENT OF REHABILITATION SERVICES
Entity Type:Organization
Organization Name:ALABAMA DEPARTMENT OF REHABILITATION SERVICES
Other - Org Name:CHILDREN'S REHABILITATION SERVICE
Other - Org Type:Other Name
Authorized Official - Title/Position:COMMISSIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:CARY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOSWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-293-7500
Mailing Address - Street 1:602 S LAWRENCE ST
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36104-4787
Mailing Address - Country:US
Mailing Address - Phone:334-293-7500
Mailing Address - Fax:334-293-7373
Practice Address - Street 1:602 S LAWRENCE ST
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36104-4787
Practice Address - Country:US
Practice Address - Phone:334-293-7500
Practice Address - Fax:334-293-7373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL528600190Medicaid