Provider Demographics
NPI:1427693373
Name:BATTISTE CERTIFIED RESIDENTIAL FACILITY LLC
Entity type:Organization
Organization Name:BATTISTE CERTIFIED RESIDENTIAL FACILITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXCUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:FRANCENE
Authorized Official - Last Name:BATTISTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-457-5409
Mailing Address - Street 1:432 GILBERT ST
Mailing Address - Street 2:
Mailing Address - City:PRICHARD
Mailing Address - State:AL
Mailing Address - Zip Code:36610-4452
Mailing Address - Country:US
Mailing Address - Phone:251-457-5409
Mailing Address - Fax:
Practice Address - Street 1:432 GILBERT ST
Practice Address - Street 2:
Practice Address - City:PRICHARD
Practice Address - State:AL
Practice Address - Zip Code:36610-4452
Practice Address - Country:US
Practice Address - Phone:251-457-5409
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-14
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities