=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043478043
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ST. ANNE'S HOME, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/27/2008
-----------------------------------------------------
Last Update Date | 05/27/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2772 HANOVER CIR S
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35205-1706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-933-2402
-----------------------------------------------------
Fax | 205-933-2479
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2772 HANOVER CIR S
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35205-1706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-933-2402
-----------------------------------------------------
Fax | 205-933-2479
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MS. JACQUELINE L. DEAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 205-933-2402
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 324500000X
-----------------------------------------------------
Taxonomy Name | Substance Abuse Rehabilitation Facility
-----------------------------------------------------
License Number | CERTIFIED
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------