Provider Demographics
NPI:1669640041
Name:BALDWIN COUNTY GIRLS RESIDENTIAL WILDERNESS PROGRAM
Entity Type:Organization
Organization Name:BALDWIN COUNTY GIRLS RESIDENTIAL WILDERNESS PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-580-1860
Mailing Address - Street 1:23750 EWING FARM ROAD
Mailing Address - Street 2:
Mailing Address - City:ATMORE
Mailing Address - State:AL
Mailing Address - Zip Code:36502-0000
Mailing Address - Country:US
Mailing Address - Phone:251-580-1860
Mailing Address - Fax:251-937-0391
Practice Address - Street 1:23750 EWING FARM ROAD
Practice Address - Street 2:
Practice Address - City:ATMORE
Practice Address - State:AL
Practice Address - Zip Code:36502-0000
Practice Address - Country:US
Practice Address - Phone:251-580-1860
Practice Address - Fax:251-937-0391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities