Provider Demographics
NPI:1205983053
Name:SOUTH ALABAMA CARES
Entity type:Organization
Organization Name:SOUTH ALABAMA CARES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:LITTLE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MS
Authorized Official - Phone:251-471-5277
Mailing Address - Street 1:PO BOX 40296
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36640-0296
Mailing Address - Country:US
Mailing Address - Phone:251-471-5277
Mailing Address - Fax:
Practice Address - Street 1:2054 DAUPHIN ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36606-1929
Practice Address - Country:US
Practice Address - Phone:251-471-5277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL59190003Medicaid