Healthcare Provider Details

I. General information

NPI: 1124574074
Provider Name (Legal Business Name): PEULTHAI HOUSE/BEHAVIORAL HEALTH DAY TREATMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2016
Last Update Date: 08/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14881 G HWY 231/431
NORTH HAZEL GREEN AL
35750
US

IV. Provider business mailing address

14881 G HWY 231
NORTH HAZEL GREEN AL
35750
US

V. Phone/Fax

Practice location:
  • Phone: 225-685-2929
  • Fax:
Mailing address:
  • Phone: 225-685-2929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateAL

VIII. Authorized Official

Name: DR. NEARL SALANDY PHILLIPS
Title or Position: CHAIR
Credential: PHD
Phone: 334-498-9466