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General NPI Number Information
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NPI Number | 1871370783
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Entity Type | Organization
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Legal Business Name | S & L RESIDENTIAL LLC
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Dates
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Enumeration Date | 09/13/2023
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Last Update Date | 09/13/2023
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Provider Practice Location Address
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Address Line | 3574 KINGS GATE DR W
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City | MOBILE
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State | AL
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Zip | 36618-4699
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Country | US
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Telephone | 251-217-4748
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Fax |
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Provider Business Mailing Address
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Address Line | 2860 DAUPHIN ST STE B
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City | MOBILE
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State | AL
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Zip | 36606-2415
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Country | US
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Telephone | 251-217-4748
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | LESLIE S JONES
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Credential |
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Telephone | 251-217-4748
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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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