Provider Demographics
NPI:1700982840
Name:CHILDREN'S PROTECTIVE ASSOCIATE INCORPORATE
Entity Type:Organization
Organization Name:CHILDREN'S PROTECTIVE ASSOCIATE INCORPORATE
Other - Org Name:BRANTWOOD - THE CHILDREN'S HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HERBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-590-8568
Mailing Address - Street 1:1309 UPPER WETUMPKA RD
Mailing Address - Street 2:1309 UPPER WETUMPKA RD.
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36107-1217
Mailing Address - Country:US
Mailing Address - Phone:334-265-0784
Mailing Address - Fax:334-265-9701
Practice Address - Street 1:1309 UPPER WETUMPKA RD
Practice Address - Street 2:1309 UPPER WETUMPKA RD.
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36107-1217
Practice Address - Country:US
Practice Address - Phone:334-265-0784
Practice Address - Fax:334-265-9701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL298322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children