Healthcare Provider Details

I. General information

NPI: 1689412736
Provider Name (Legal Business Name): DEARBORN HOMES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2024
Last Update Date: 07/15/2024
Certification Date: 07/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3151-A KNOLLWOOD DRIVE MOBILE, AL 36693
MOBILE AL
36693
US

IV. Provider business mailing address

1200 GRANDE OAK BLVD APT 1102
SARALAND AL
36571-3741
US

V. Phone/Fax

Practice location:
  • Phone: 251-661-7608
  • Fax:
Mailing address:
  • Phone: 251-533-0642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TISUNGANE BLESSING CHIWEMBU
Title or Position: NURSE PRACTITIONER
Credential: NURSE PRACTITIONER
Phone: 251-533-0642