Provider Demographics
NPI:1861366312
Name:BIG BROTHER TRANSITIONAL LIVING INC
Entity type:Organization
Organization Name:BIG BROTHER TRANSITIONAL LIVING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:R
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-300-0767
Mailing Address - Street 1:27900 JAPONICA LN
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-5248
Mailing Address - Country:US
Mailing Address - Phone:251-300-0767
Mailing Address - Fax:251-468-2021
Practice Address - Street 1:5320 MOFFETT RD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36618-2904
Practice Address - Country:US
Practice Address - Phone:251-300-0767
Practice Address - Fax:251-468-2021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-29
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health