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General NPI Number Information
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NPI Number | 1164686754
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Entity Type | Organization
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Legal Business Name | CED FELLOWSHIP HOUSE, INC.
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Dates
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Enumeration Date | 07/14/2008
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Last Update Date | 07/14/2008
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Provider Practice Location Address
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Address Line | 4209 BROOKE AVE
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City | GADSDEN
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State | AL
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Zip | 35904-8300
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Country | US
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Telephone | 256-413-3470
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Fax | 256-413-3472
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Provider Business Mailing Address
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Address Line | 4209 BROOKE AVE
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City | GADSDEN
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State | AL
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Zip | 35904-8300
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Country | US
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Telephone | 256-413-3470
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Fax | 256-413-3472
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. RANNIE JAY CHILDRESS
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Credential | MS, NCAC II, SAP
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Telephone | 256-413-3470
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State | AL
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