Healthcare Provider Details

I. General information

NPI: 1942140702
Provider Name (Legal Business Name): HOUSE OF MARY JOE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001C WILKES RD
MIDFIELD AL
35228-3233
US

IV. Provider business mailing address

1001C WILKES RD
MIDFIELD AL
35228-3233
US

V. Phone/Fax

Practice location:
  • Phone: 205-337-6366
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHAVATEY POWELL
Title or Position: OWNER/DIRECTOR
Credential:
Phone: 205-337-6366