MEDICARE: PHP OF ALABAMA, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility

General Provider Information

NPI Number	:	1467599282
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHP OF ALABAMA, INC.

Provider Business Mailing Address
First Line	:	468 HALLE PARK DR
Second Line	:
City	:	COLLIERVILLE
State	:	TN
Zip	:	38017-7089
Country	:	US
Telephone Number	:	901-692-5555
Fax Number	:	901-692-5561

Provider Business Practice Location Address
First Line	:	62 RED EAGLE PKWY
Second Line	:
City	:	WETUMPKA
State	:	AL
Zip	:	36092-2052
Country	:	US
Telephone Number	:	334-567-3729
Fax Number	:	334-514-6776

Authorized Official
Title or Position	:	CONTROLLER
Name	:	MR. WAYNE T ADDISON
Credential	:
Telephone Number	:	901-692-5555

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	08/22/2020

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Directions to “PHP OF ALABAMA, INC. ” Practice Location

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