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General NPI Number Information
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NPI Number | 1437159290
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Entity Type | Organization
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Legal Business Name | PHP OF ALABAMA
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Dates
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Enumeration Date | 07/22/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 62 RED EAGLE PKWY
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City | WETUMPKA
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State | AL
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Zip | 36092-2052
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Country | US
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Telephone | 334-567-3729
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Fax | 334-514-6776
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Provider Business Mailing Address
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Address Line | 62 RED EAGLE PKWY
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City | WETUMPKA
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State | AL
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Zip | 36092-2052
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Country | US
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Telephone | 334-567-3729
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Fax | 334-514-6776
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. JON BURNS
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Credential |
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Telephone | 334-567-3729
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number | 480
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License Number State | AL
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