Provider Demographics
NPI:1427231083
Name:BLACKWELL'S WAY
Entity Type:Organization
Organization Name:BLACKWELL'S WAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANA
Authorized Official - Middle Name:JILL
Authorized Official - Last Name:BLACKWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-623-3448
Mailing Address - Street 1:4140 COUNTY RD 43
Mailing Address - Street 2:
Mailing Address - City:FYFFE
Mailing Address - State:AL
Mailing Address - Zip Code:35971
Mailing Address - Country:US
Mailing Address - Phone:256-623-3448
Mailing Address - Fax:
Practice Address - Street 1:4140 COUNTY RD 43
Practice Address - Street 2:
Practice Address - City:FYFFE
Practice Address - State:AL
Practice Address - Zip Code:35971
Practice Address - Country:US
Practice Address - Phone:256-623-3448
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities