Organization
BLANKET FORT HOPE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KIMBERLY W MASHEGO LICSW (EXECUTIVE DIRECTOR)
(205) 602-4892
Entity
Organization
Contact information
Practice address
24809 ALABAMA HIGHWAY 25, COLUMBIANA, AL 35051-3512
(205) 602-4892
(205) 602-4892
Mailing address
PO BOX 212, COLUMBIANA, AL 35051-0212
(205) 602-4892
(205) 602-4892
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
02/13/2024
Last updated
02/13/2024
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