MEDICARE: HANDICAPPED ENVIROMENTAL LIVING PROGRAM, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251K00000X	Public Health or Welfare Agency	251S00000X	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982883658
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HANDICAPPED ENVIROMENTAL LIVING PROGRAM, INC.

Provider Business Mailing Address
First Line	:	2820 MILTON RD
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36110-1312
Country	:	US
Telephone Number	:	334-269-5762
Fax Number	:	334-269-5709

Provider Business Practice Location Address
First Line	:	2820 MILTON RD
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36110-1312
Country	:	US
Telephone Number	:	334-269-5762
Fax Number	:	334-269-5709

Authorized Official
Title or Position	:	BOOKKEEPER
Name	:	MS. PAMELA T. KNOX
Credential	:
Telephone Number	:	334-230-1945

Provider Enumeration Date	:	10/30/2007
Last Update Date	:	10/30/2007

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