Provider Demographics
NPI:1285804666
Name:FIRST LIGHT COMMUNITY OF MOBILE
Entity type:Organization
Organization Name:FIRST LIGHT COMMUNITY OF MOBILE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:E
Authorized Official - Last Name:O'MALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-438-2094
Mailing Address - Street 1:151 S ANN ST
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36604-2302
Mailing Address - Country:US
Mailing Address - Phone:251-438-2094
Mailing Address - Fax:
Practice Address - Street 1:151 S ANN ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36604-2302
Practice Address - Country:US
Practice Address - Phone:251-438-2094
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL008313000251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health