Provider Demographics
NPI:1982850491
Name:NORTH CENTRAL ALABAMA MENTAL RETARDATION AUTHORITY, INC.
Entity Type:Organization
Organization Name:NORTH CENTRAL ALABAMA MENTAL RETARDATION AUTHORITY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EARL
Authorized Official - Middle Name:E
Authorized Official - Last Name:BRIGHTWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-355-7315
Mailing Address - Street 1:445 MOULTON ST E
Mailing Address - Street 2:P.O. BOX 597
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-3000
Mailing Address - Country:US
Mailing Address - Phone:256-355-7315
Mailing Address - Fax:256-355-7315
Practice Address - Street 1:445 MOULTON ST E
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-3000
Practice Address - Country:US
Practice Address - Phone:256-355-7315
Practice Address - Fax:256-355-7315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-15
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL591500001Medicaid