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General NPI Number Information
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NPI Number | 1033093844
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Entity Type | Organization
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Legal Business Name | FAIRHOPE RESIDENTIAL LLC
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Dates
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Enumeration Date | 08/04/2025
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Last Update Date | 08/04/2025
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Provider Practice Location Address
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Address Line | 18874 SUMMER OAKS PL
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City | FAIRHOPE
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State | AL
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Zip | 36532-4721
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Country | US
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Telephone | 270-869-7934
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Fax |
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Provider Business Mailing Address
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Address Line | 20777 NOBLEMAN DR
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City | FAIRHOPE
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State | AL
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Zip | 36532-4658
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Country | US
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Telephone | 270-869-7934
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. JOHN THOMAS MICHAEL
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Credential | RN
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Telephone | 270-869-7934
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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