Provider Demographics
NPI:1194905687
Name:SHOALS COMMITTEE ON PROGRAMS AND EMPLOYMENT FOR THE MENTALLY RETARDED
Entity type:Organization
Organization Name:SHOALS COMMITTEE ON PROGRAMS AND EMPLOYMENT FOR THE MENTALLY RETARDED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ARVY
Authorized Official - Middle Name:GLENN
Authorized Official - Last Name:DUPUY
Authorized Official - Suffix:III
Authorized Official - Credentials:MS
Authorized Official - Phone:256-768-0901
Mailing Address - Street 1:201 S COURT ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-5609
Mailing Address - Country:US
Mailing Address - Phone:256-768-0903
Mailing Address - Fax:256-768-0518
Practice Address - Street 1:201 S COURT ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-5609
Practice Address - Country:US
Practice Address - Phone:256-768-0903
Practice Address - Fax:256-768-0518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health