Provider Demographics
NPI:1497808539
Name:A&E SUPPORTED LIVING, INC.
Entity Type:Organization
Organization Name:A&E SUPPORTED LIVING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:EZELL
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:251-232-2548
Mailing Address - Street 1:3204 WELLBORNE DR E
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36695-3273
Mailing Address - Country:US
Mailing Address - Phone:251-232-2548
Mailing Address - Fax:251-661-5080
Practice Address - Street 1:600 BEL AIR BLVD
Practice Address - Street 2:SUITE 240
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36606-3501
Practice Address - Country:US
Practice Address - Phone:251-232-2548
Practice Address - Fax:251-661-5080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-20
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities