Provider Demographics
NPI:1104572254
Name:INDEPENDENT LIVING CENTER OF BIRMINGHAM
Entity type:Organization
Organization Name:INDEPENDENT LIVING CENTER OF BIRMINGHAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:STANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-815-6142
Mailing Address - Street 1:PO BOX 1805
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35201-1805
Mailing Address - Country:US
Mailing Address - Phone:205-815-6142
Mailing Address - Fax:
Practice Address - Street 1:1418 6TH AVE N
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35203-1804
Practice Address - Country:US
Practice Address - Phone:205-815-6142
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-28
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services