Provider Demographics
NPI:1639059975
Name:FANCY HOMES LLC
Entity type:Organization
Organization Name:FANCY HOMES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:ABDALLAH
Authorized Official - Last Name:LATAYFA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-990-9225
Mailing Address - Street 1:103 GARDEN VIEW LN APT 103
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-1841
Mailing Address - Country:US
Mailing Address - Phone:318-990-9225
Mailing Address - Fax:
Practice Address - Street 1:3757 SEASIDE SPARROW CIR
Practice Address - Street 2:
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35022-4719
Practice Address - Country:US
Practice Address - Phone:318-990-9225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-05
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities