Provider Demographics
NPI:1982883658
Name:HANDICAPPED ENVIROMENTAL LIVING PROGRAM, INC.
Entity type:Organization
Organization Name:HANDICAPPED ENVIROMENTAL LIVING PROGRAM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOOKKEEPER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:T
Authorized Official - Last Name:KNOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-230-1945
Mailing Address - Street 1:2820 MILTON RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36110-1312
Mailing Address - Country:US
Mailing Address - Phone:334-269-5762
Mailing Address - Fax:334-269-5709
Practice Address - Street 1:2820 MILTON RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36110-1312
Practice Address - Country:US
Practice Address - Phone:334-269-5762
Practice Address - Fax:334-269-5709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL251S00000X251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL8464000OtherMEDICAID PROVIDER NUMBER