Provider Demographics
NPI:1033093844
Name:FAIRHOPE RESIDENTIAL LLC
Entity type:Organization
Organization Name:FAIRHOPE RESIDENTIAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:MICHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:270-869-7934
Mailing Address - Street 1:20777 NOBLEMAN DR
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-4658
Mailing Address - Country:US
Mailing Address - Phone:270-869-7934
Mailing Address - Fax:
Practice Address - Street 1:18874 SUMMER OAKS PL
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-4721
Practice Address - Country:US
Practice Address - Phone:270-869-7934
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities