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Organization

MARY'S LEGACY HOMES, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. SHALETTA DAVIS LBSW (EXECUTIVE DIRECTOR)
(334) 412-1418
Entity
Organization

Contact information

Practice address
5842 SANROCK TERRACE DR, MONTGOMERY, AL 36116-6550
(334) 593-5173
(334) 593-0376
Mailing address
1803 SHOREHAM DR, MONTGOMERY, AL 36106-2716
(334) 412-1418
(334) 593-0376

Taxonomy

Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary

Other

Enumeration date
08/28/2023
Last updated
09/15/2023
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