Provider Demographics
NPI:1164686754
Name:CED FELLOWSHIP HOUSE, INC.
Entity Type:Organization
Organization Name:CED FELLOWSHIP HOUSE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RANNIE
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:CHILDRESS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, NCAC II, SAP
Authorized Official - Phone:256-413-3470
Mailing Address - Street 1:4209 BROOKE AVE
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35904-8300
Mailing Address - Country:US
Mailing Address - Phone:256-413-3470
Mailing Address - Fax:256-413-3472
Practice Address - Street 1:4209 BROOKE AVE
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35904-8300
Practice Address - Country:US
Practice Address - Phone:256-413-3470
Practice Address - Fax:256-413-3472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility