Provider Demographics
NPI:1063910552
Name:MEADOWS PLACE GROUP HOME INC
Entity type:Organization
Organization Name:MEADOWS PLACE GROUP HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALTHELDA
Authorized Official - Middle Name:CAMPBELL
Authorized Official - Last Name:STALLWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-209-1894
Mailing Address - Street 1:3220 MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36618-4638
Mailing Address - Country:US
Mailing Address - Phone:251-209-1894
Mailing Address - Fax:251-459-0991
Practice Address - Street 1:3220 MEADOW LN
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36618-4638
Practice Address - Country:US
Practice Address - Phone:251-209-1894
Practice Address - Fax:251-459-0991
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEADOWS PLACE GROUP HOME INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-30
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities