Healthcare Provider Details

I. General information

NPI: 1902041080
Provider Name (Legal Business Name): ANTONIO DEON DALE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2008
Last Update Date: 12/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

544 SINGLETON ST
MOBILE AL
36610-4725
US

IV. Provider business mailing address

PO BOX 13726
MOBILE AL
36663-0726
US

V. Phone/Fax

Practice location:
  • Phone: 251-456-7589
  • Fax: 251-452-0568
Mailing address:
  • Phone: 251-456-7589
  • Fax: 251-452-0568

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:
Title or Position:
Credential:
Phone: