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General NPI Number Information
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NPI Number | 1942885850
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Entity Type | Organization
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Legal Business Name | A SPECIAL PLACE FOR KIDS, LLC
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Dates
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Enumeration Date | 03/11/2021
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Last Update Date | 03/11/2021
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Provider Practice Location Address
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Address Line | 1108 MAIN STREET GARDENDALE
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City | GARDENDALE
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State | AL
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Zip | 35071
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Country | US
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Telephone | 205-285-5078
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Fax | 205-533-9927
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Provider Business Mailing Address
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Address Line | PO BOX 2010
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City | GARDENDALE
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State | AL
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Zip | 35071-1880
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Country | US
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Telephone | 205-285-5078
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Fax | 205-533-9927
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Authorized Official
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Title or Position | OWNER
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Name | DAWN JANEL JOHNSON
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Credential |
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Telephone | 205-616-4078
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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