Healthcare Provider Details

I. General information

NPI: 1518062488
Provider Name (Legal Business Name): SOUTHEAST ALABAMA HUMAN DEVELOPMENT COUNCIL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1057 COUNTY ROAD 53
ABBEVILLE AL
36310-6443
US

IV. Provider business mailing address

PO BOX 565
ABBEVILLE AL
36310-0565
US

V. Phone/Fax

Practice location:
  • Phone: 334-585-0250
  • Fax:
Mailing address:
  • Phone: 334-585-0250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number StateAL

VIII. Authorized Official

Name: MRS. IDENA BAKER
Title or Position: DIRECTOR
Credential:
Phone: 334-585-0250