Provider Demographics
NPI:1407869951
Name:BIG BEN'SGROUP HOME
Entity Type:Organization
Organization Name:BIG BEN'SGROUP HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTER
Authorized Official - Prefix:MR
Authorized Official - First Name:BENNIE
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-655-5406
Mailing Address - Street 1:112 N BELL ST
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-4308
Mailing Address - Country:US
Mailing Address - Phone:334-793-5406
Mailing Address - Fax:334-793-5406
Practice Address - Street 1:112 N BELL ST
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-4308
Practice Address - Country:US
Practice Address - Phone:334-793-5406
Practice Address - Fax:334-793-5406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children