Provider Demographics
NPI:1902041080
Name:DALE, ANTONIO DEON
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:DEON
Last Name:DALE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13726
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36663-0726
Mailing Address - Country:US
Mailing Address - Phone:251-456-7589
Mailing Address - Fax:251-452-0568
Practice Address - Street 1:544 SINGLETON ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36610-4725
Practice Address - Country:US
Practice Address - Phone:251-456-7589
Practice Address - Fax:251-452-0568
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child