=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437063757
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PIWI INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/01/2026
-----------------------------------------------------
Last Update Date | 10/01/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2907 MEADOWLAKE AVE
-----------------------------------------------------
City | NORTHPORT
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35473-8071
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-764-3419
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14607 OLE OAK DR
-----------------------------------------------------
City | COALING
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35453-2306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | PHILLIP IKE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 205-219-1686
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 320600000X
-----------------------------------------------------
Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NULL
-----------------------------------------------------