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General NPI Number Information
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NPI Number | 1033990171
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Entity Type | Organization
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Legal Business Name | EMMANUEL HOUSE
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Dates
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Enumeration Date | 10/12/2023
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Last Update Date | 10/12/2023
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Provider Practice Location Address
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Address Line | 5001 CYPRESS CREEK AVE E
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City | TUSCALOOSA
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State | AL
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Zip | 35405-6017
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Country | US
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Telephone | 205-242-6277
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Fax |
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Provider Business Mailing Address
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Address Line | 23 CRESTLINE DR
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City | TUSCALOOSA
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State | AL
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Zip | 35405-4170
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Country | US
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Telephone | 205-242-6277
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MRS. DONNA BAILEY
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Credential |
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Telephone | 205-242-6277
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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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