Organization
STATE OF ALABAMA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MALISSIA WARD (RN)
(205) 331-4747
Entity
Organization
Contact information
Practice address
200 UNIVERSITY BLVD, TUSCALOOSA, AL 35401-1250
(205) 759-0682
Mailing address
2406 DEER HAVEN DR, NORTHPORT, AL 35473-3051
(205) 331-4747
Taxonomy
Speciality
Code
Description
License number
State
283Q00000X
Psychiatric Hospital
Primary
1-123265
AL
Other
Enumeration date
05/08/2012
Last updated
05/08/2012
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