MEDICARE: FAMILY GARDEN 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	253J00000X	Foster Care Agency

General Provider Information

NPI Number	:	1609287788
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY GARDEN INC

Provider Business Mailing Address
First Line	:	640 MOBB HILL RD
Second Line	:
City	:	UNION GROVE
State	:	AL
Zip	:	35175-9091
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	640 MOBB HILL RD
Second Line	:
City	:	UNION GROVE
State	:	AL
Zip	:	35175-9091
Country	:	US
Telephone Number	:	256-506-6100
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	DAVID HAROLD COLE
Credential	:	LPC, LMFT
Telephone Number	:	256-506-6100

Provider Enumeration Date	:	05/12/2014
Last Update Date	:	05/12/2014

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Directions to “FAMILY GARDEN INC ” Practice Location

Language	Start Address	Practice Location

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