Healthcare Provider Details

I. General information

NPI: 1992818488
Provider Name (Legal Business Name): PRESBYTERIAN HOME FOR CHILDREN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 ASHLAND HWY
TALLADEGA AL
35160-2586
US

IV. Provider business mailing address

PO BOX 577
TALLADEGA AL
35161-0577
US

V. Phone/Fax

Practice location:
  • Phone: 256-362-2114
  • Fax: 256-362-0120
Mailing address:
  • Phone: 256-362-2114
  • Fax: 256-362-0120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number10399
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number StateAL

VIII. Authorized Official

Name: MR. WILLIAM S. WILLS
Title or Position: PRESIDENT
Credential:
Phone: 256-362-2114