Provider Demographics
NPI:1982734752
Name:THE SALVATION ARMY, A GEORGIA CORPORATION
Entity Type:Organization
Organization Name:THE SALVATION ARMY, A GEORGIA CORPORATION
Other - Org Name:THE SALVATION ARMY DAUPHIN WAY LODGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:RN
Authorized Official - Last Name:GOODIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-728-6755
Mailing Address - Street 1:1009 DAUPHIN ST
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36604-2509
Mailing Address - Country:US
Mailing Address - Phone:251-438-4729
Mailing Address - Fax:251-438-7742
Practice Address - Street 1:1009 DAUPHIN ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36604-2509
Practice Address - Country:US
Practice Address - Phone:251-438-4729
Practice Address - Fax:251-438-7742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder