Organization
MONTELISSA FULL LIFE RESOURCES, INC
Active
Other names
Montelissa Residential
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DENISE JOHNSON MASON (CEO)
(256) 345-3996
Entity
Organization
Contact information
Practice address
1008 CLARKVIEW ST SW, DECATUR, AL 35601-6204
(256) 686-1411
Mailing address
1008 CLARKVIEW ST SW, DECATUR, AL 35601-6204
(256) 686-1411
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
—
—
Other
Enumeration date
12/15/2012
Last updated
12/15/2012
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