Provider Demographics
NPI:1386654648
Name:WILMER HALL EPISCOPAL CHILDREN'S HOME
Entity Type:Organization
Organization Name:WILMER HALL EPISCOPAL CHILDREN'S HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:M
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:MED,LPC
Authorized Official - Phone:251-342-4931
Mailing Address - Street 1:3811 OLD SHELL RD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-1317
Mailing Address - Country:US
Mailing Address - Phone:251-342-4931
Mailing Address - Fax:251-342-1782
Practice Address - Street 1:3811 OLD SHELL RD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-1317
Practice Address - Country:US
Practice Address - Phone:251-342-4931
Practice Address - Fax:251-342-1782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL000264322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL33090266Medicaid
AL33090166Medicaid