Healthcare Provider Details

I. General information

NPI: 1851561351
Provider Name (Legal Business Name): WOMEN IN CRISIS OUTREACH MINISTRY & SHELTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2008
Last Update Date: 06/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9030 BROADUS LOOP RD
MOBILE AL
36613-9616
US

IV. Provider business mailing address

9030 BROADUS LOOP RD
MOBILE AL
36613-9616
US

V. Phone/Fax

Practice location:
  • Phone: 251-649-9440
  • Fax:
Mailing address:
  • Phone: 251-649-9440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number
License Number StateAL
# 4
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateAL
# 5
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateAL

VIII. Authorized Official

Name: MRS. WANDA L. RANDOLPH
Title or Position: C.E.O./PASTOR
Credential: BISHOP
Phone: 251-649-9440