Healthcare Provider Details

I. General information

NPI: 1497229173
Provider Name (Legal Business Name): CDP COMMUNITY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2019
Last Update Date: 03/25/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1904 GLORIA YORK AVE
MOBILE AL
36617-3409
US

IV. Provider business mailing address

2060 OCONNOR ST
MOBILE AL
36617-2619
US

V. Phone/Fax

Practice location:
  • Phone: 251-259-0857
  • Fax:
Mailing address:
  • Phone: 251-259-0857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: COURTNEY SIMS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 251-259-0857