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General NPI Number Information
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NPI Number | 1861366312
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Entity Type | Organization
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Legal Business Name | BIG BROTHER TRANSITIONAL LIVING INC
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Dates
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Enumeration Date | 09/29/2025
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Last Update Date | 10/03/2025
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Provider Practice Location Address
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Address Line | 5320 MOFFETT RD
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City | MOBILE
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State | AL
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Zip | 36618-2904
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Country | US
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Telephone | 251-300-0767
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Fax | 251-468-2021
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Provider Business Mailing Address
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Address Line | 27900 JAPONICA LN
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City | DAPHNE
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State | AL
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Zip | 36526-5248
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Country | US
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Telephone | 251-300-0767
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Fax | 251-468-2021
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Authorized Official
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Title or Position | DIRECTOR
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Name | KENNETH R JOHNSON
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Credential |
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Telephone | 251-300-0767
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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