Provider Demographics
NPI:1487104998
Name:SOUTHERN ALABAMA REGIONAL COUNCIL ON AGING
Entity type:Organization
Organization Name:SOUTHERN ALABAMA REGIONAL COUNCIL ON AGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:EIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-793-6843
Mailing Address - Street 1:1075 S BRANNON STAND RD
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-7359
Mailing Address - Country:US
Mailing Address - Phone:334-793-6843
Mailing Address - Fax:
Practice Address - Street 1:1075 S BRANNON STAND RD
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-7359
Practice Address - Country:US
Practice Address - Phone:334-793-6843
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-07
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X
AL1-054943163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes EducatorGroup - Single Specialty
No251B00000XAgenciesCase ManagementGroup - Single Specialty