Provider Demographics
NPI:1720129455
Name:EASTER SEALS CENTRAL ALABAMA
Entity Type:Organization
Organization Name:EASTER SEALS CENTRAL ALABAMA
Other - Org Name:EASTER SEALS CENTRAL ALABAMA REHABILITATION CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR BUSINESS AND FINACE
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:B
Authorized Official - Last Name:JARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-288-0240
Mailing Address - Street 1:2125 E SOUTH BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116-2409
Mailing Address - Country:US
Mailing Address - Phone:334-288-0240
Mailing Address - Fax:334-288-7171
Practice Address - Street 1:2125 E SOUTH BLVD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-2409
Practice Address - Country:US
Practice Address - Phone:334-288-0240
Practice Address - Fax:334-288-7171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51009328OtherBLUE CROSS BLUE SHIELD
AL529101030Medicaid
AL51009328OtherBLUE CROSS BLUE SHIELD
=========OtherAETNA
=========OtherUNITED HEALTHCARE
AL51009328OtherBLUE CROSS BLUE SHIELD