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General NPI Number Information
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NPI Number | 1639059975
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Entity Type | Organization
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Legal Business Name | FANCY HOMES LLC
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Dates
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Enumeration Date | 09/05/2025
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Last Update Date | 09/05/2025
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Provider Practice Location Address
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Address Line | 3757 SEASIDE SPARROW CIR
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City | BESSEMER
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State | AL
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Zip | 35022-4719
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Country | US
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Telephone | 318-990-9225
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Fax |
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Provider Business Mailing Address
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Address Line | 103 GARDEN VIEW LN APT 103
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City | HOOVER
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State | AL
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Zip | 35244-1841
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Country | US
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Telephone | 318-990-9225
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MOHAMMAD ABDALLAH LATAYFA
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Credential |
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Telephone | 318-990-9225
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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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