# MONTELISSA FULL LIFE RESOURCES, INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Montelissa Residential
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063758282
- **Authorized official:** MS. DENISE JOHNSON MASON (CEO)
- **Authorized official phone:** (256) 345-3996

## Contact information

- **Practice address:** 1008 CLARKVIEW ST SW, DECATUR, AL 35601-6204
- **Practice address phone:** (256) 686-1411
- **Mailing address:** 1008 CLARKVIEW ST SW, DECATUR, AL 35601-6204
- **Mailing address phone:** (256) 686-1411

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302F00000X | Exclusive Provider Organization | — | NULL | Yes |

## Other

- **Enumeration date:** 12/15/2012
- **Last updated:** 12/15/2012