=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013357417
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HUFF INDUSTRIES INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/28/2013
-----------------------------------------------------
Last Update Date | 06/28/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 55260 COUNTY ROAD 21
-----------------------------------------------------
City | STOCKTON
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36579-4144
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-508-0872
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 55260 COUNTY ROAD 21
-----------------------------------------------------
City | STOCKTON
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36579-4144
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-508-0872
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PESIDENT/CEO
-----------------------------------------------------
Name | WILLIE ALFRED HUFF JR.
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 251-508-0872
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251C00000X
-----------------------------------------------------
Taxonomy Name | Developmentally Disabled Services Day Training Agency
-----------------------------------------------------
License Number | 339009066
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------