Provider Demographics
NPI:1265665814
Name:JLW PLACE INC.
Entity Type:Organization
Organization Name:JLW PLACE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:SR
Authorized Official - Credentials:LPN
Authorized Official - Phone:251-367-2139
Mailing Address - Street 1:PO BOX 497
Mailing Address - Street 2:
Mailing Address - City:SARALAND
Mailing Address - State:AL
Mailing Address - Zip Code:36571-0497
Mailing Address - Country:US
Mailing Address - Phone:251-367-2139
Mailing Address - Fax:251-442-0706
Practice Address - Street 1:472 LOTT RD
Practice Address - Street 2:
Practice Address - City:EIGHT MILE
Practice Address - State:AL
Practice Address - Zip Code:36613-3533
Practice Address - Country:US
Practice Address - Phone:251-367-2139
Practice Address - Fax:251-442-0706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-31
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2-044907320600000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies