Healthcare Provider Details

I. General information

NPI: 1417763699
Provider Name (Legal Business Name): LIZANDLAMAR MENTAL HEALTH GROUP HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2024
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5330 MOFFETT RD
MOBILE AL
36618-2904
US

IV. Provider business mailing address

5330 MOFFETT RD
MOBILE AL
36618-2904
US

V. Phone/Fax

Practice location:
  • Phone: 251-487-5182
  • Fax:
Mailing address:
  • Phone: 251-487-5182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. TAMMY L CEASOR
Title or Position: OWNER
Credential:
Phone: 251-487-5182