Healthcare Provider Details

I. General information

NPI: 1033479142
Provider Name (Legal Business Name): CARING BOARDING HOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2012
Last Update Date: 05/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2054 ROBINSON DR APT D
MOBILE AL
36605-5176
US

IV. Provider business mailing address

2054 ROBINSON DR APT D
MOBILE AL
36605-5176
US

V. Phone/Fax

Practice location:
  • Phone: 251-234-9499
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: DEBRA TUCKER
Title or Position: OWNER
Credential:
Phone: 251-234-9499