Healthcare Provider Details

I. General information

NPI: 1609977503
Provider Name (Legal Business Name): NEW WAY OUT, CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 OAK CIRCLE DR E
MOBILE AL
36609-4222
US

IV. Provider business mailing address

PO BOX 191533
MOBILE AL
36619-6533
US

V. Phone/Fax

Practice location:
  • Phone: 251-665-4627
  • Fax: 251-666-9599
Mailing address:
  • Phone: 251-665-4627
  • Fax: 251-661-9599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number322D0000X
License Number StateAL

VIII. Authorized Official

Name: MRS. ANNEASE PETWAY
Title or Position: OWNER
Credential: MSW
Phone: 251-665-4627