Healthcare Provider Details

I. General information

NPI: 1952582181
Provider Name (Legal Business Name): BURROWES GROUP COMMUNITY & ECONOMIC DEVELOPMENT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2007
Last Update Date: 11/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1610 ROACH ST
MOBILE AL
36617-1819
US

IV. Provider business mailing address

1610 ROACH ST
MOBILE AL
36617-1819
US

V. Phone/Fax

Practice location:
  • Phone: 251-457-7090
  • Fax:
Mailing address:
  • Phone: 251-457-7090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number3206000000X
License Number State

VIII. Authorized Official

Name: MRS. STEPHANIE YORK BURROWES
Title or Position: EXECUTIVE DIRECTOR
Credential: MED
Phone: 251-457-7090