Provider Demographics
NPI:1124574074
Name:PEULTHAI HOUSE/BEHAVIORAL HEALTH DAY TREATMENT CENTER
Entity Type:Organization
Organization Name:PEULTHAI HOUSE/BEHAVIORAL HEALTH DAY TREATMENT CENTER
Other - Org Name:BEHAVIORAL HEALTH DAY TREATMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIR
Authorized Official - Prefix:DR
Authorized Official - First Name:NEARL
Authorized Official - Middle Name:SALANDY
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:334-498-9466
Mailing Address - Street 1:14881 G HWY 231
Mailing Address - Street 2:
Mailing Address - City:NORTH HAZEL GREEN
Mailing Address - State:AL
Mailing Address - Zip Code:35750
Mailing Address - Country:US
Mailing Address - Phone:225-685-2929
Mailing Address - Fax:
Practice Address - Street 1:14881 G HWY 231/431
Practice Address - Street 2:
Practice Address - City:NORTH HAZEL GREEN
Practice Address - State:AL
Practice Address - Zip Code:35750
Practice Address - Country:US
Practice Address - Phone:225-685-2929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL261QA0600X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health