Healthcare Provider Details

I. General information

NPI: 1437063757
Provider Name (Legal Business Name): PIWI INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2907 MEADOWLAKE AVE
NORTHPORT AL
35473-8071
US

IV. Provider business mailing address

14607 OLE OAK DR
COALING AL
35453-2306
US

V. Phone/Fax

Practice location:
  • Phone: 205-764-3419
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number StateNULL

VIII. Authorized Official

Name: PHILLIP IKE
Title or Position: OWNER
Credential:
Phone: 205-219-1686