Provider Demographics
NPI:1124397963
Name:BLACKWELL FOSTER HOME
Entity Type:Organization
Organization Name:BLACKWELL FOSTER HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACKWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-659-6649
Mailing Address - Street 1:743 COUNTY ROAD 18
Mailing Address - Street 2:
Mailing Address - City:FYFFE
Mailing Address - State:AL
Mailing Address - Zip Code:35971
Mailing Address - Country:US
Mailing Address - Phone:256-659-6649
Mailing Address - Fax:
Practice Address - Street 1:743 COUNTY ROAD 18
Practice Address - Street 2:
Practice Address - City:FYFFE
Practice Address - State:AL
Practice Address - Zip Code:35971-3907
Practice Address - Country:US
Practice Address - Phone:256-659-6649
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-23
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities