Provider Demographics
NPI:1447498233
Name:ALABAMA YOUTH HOME
Entity type:Organization
Organization Name:ALABAMA YOUTH HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TOOLE
Authorized Official - Suffix:
Authorized Official - Credentials:LGSW
Authorized Official - Phone:206-678-4449
Mailing Address - Street 1:PO BOX 66
Mailing Address - Street 2:
Mailing Address - City:WESTOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35185-0066
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6025 HIGHWAY 51
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:AL
Practice Address - Zip Code:35186-6312
Practice Address - Country:US
Practice Address - Phone:205-678-4449
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-02
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities