Healthcare Provider Details

I. General information

NPI: 1629734397
Provider Name (Legal Business Name): FRUITS OF APPLE TREE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2021
Last Update Date: 11/16/2021
Certification Date: 11/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 19TH ST S
BESSEMER AL
35020-5864
US

IV. Provider business mailing address

27 LATO RD
SEALE AL
36875-4001
US

V. Phone/Fax

Practice location:
  • Phone: 770-861-8129
  • Fax:
Mailing address:
  • Phone: 770-861-8129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. GARRETT MURRAY JR.
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 770-861-8129