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General NPI Number Information
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NPI Number | 1023068459
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Entity Type | Organization
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Legal Business Name | BAYOU LA BATRE AREA HEALTH DEVELOPMENT BOARD, INC.
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Dates
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Enumeration Date | 05/10/2006
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Last Update Date | 04/25/2013
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Provider Practice Location Address
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Address Line | 7777 HIGHWAY 43 NORTH
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City | MCINTOSH
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State | AL
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Zip | 36553-0415
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Country | US
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Telephone | 251-944-2842
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Fax | 251-944-8070
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Provider Business Mailing Address
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Address Line | P.O. BOX 415 7777 HWY 43 NORTH
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City | MC INTOSH
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State | AL
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Zip | 36553-0415
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Country | US
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Telephone | 251-944-2842
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Fax | 251-944-8070
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. JAMES A. HOLLAND
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Credential | MPH
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Telephone | 251-824-2174
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | PHL L6503
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License Number State | AL
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