Healthcare Provider Details

I. General information

NPI: 1528926896
Provider Name (Legal Business Name): YELLOW RIVER RESIDENTIAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2026
Last Update Date: 01/14/2026
Certification Date: 01/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 CAMPBELL DR
TUSKEGEE AL
36083-2319
US

IV. Provider business mailing address

401 CAMPBELL DR
TUSKEGEE AL
36083-2319
US

V. Phone/Fax

Practice location:
  • Phone: 334-657-5700
  • Fax: 334-657-5700
Mailing address:
  • Phone: 334-657-5700
  • Fax: 334-657-5700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMILA CHANTILE WALKER
Title or Position: CO OWNER
Credential: OTR/L
Phone: 334-657-5700