Healthcare Provider Details

I. General information

NPI: 1063549103
Provider Name (Legal Business Name): PARKER ADULT FOSTER HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

671 STANTON RD
MOBILE AL
36617-2205
US

IV. Provider business mailing address

PO BOX 40847
MOBILE AL
36640-0847
US

V. Phone/Fax

Practice location:
  • Phone: 251-456-7100
  • Fax: 251-456-7146
Mailing address:
  • Phone: 251-456-7100
  • Fax: 251-456-7146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number119223
License Number StateAL

VIII. Authorized Official

Name: MRS. CAROL PARKER
Title or Position: EXECUTIVE DIRECTOR
Credential: SOCIAL WORKER
Phone: 251-456-7100