Healthcare Provider Details

I. General information

NPI: 1922170109
Provider Name (Legal Business Name): DOTHAN HOUSTON COUNTY MENTAL RETARDATION BOARD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2715 FLYNN RD
DOTHAN AL
36303-1162
US

IV. Provider business mailing address

2715 FLYNN RD
DOTHAN AL
36303-1162
US

V. Phone/Fax

Practice location:
  • Phone: 334-793-3102
  • Fax: 334-793-7740
Mailing address:
  • Phone: 334-793-3102
  • Fax: 334-793-7740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateAL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. ED DORSEY
Title or Position: EXECUTIVE DIRECTOR
Credential: B.S.
Phone: 334-793-3102