1760595896 NPI number — LIFECARE OF ALABAMA, INC.

Table of content: (NPI 1760595896)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760595896 NPI number — LIFECARE OF ALABAMA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIFECARE OF ALABAMA, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760595896
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1105
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARTSELLE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35640-1105
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-773-6035
Provider Business Mailing Address Fax Number:
256-751-4855

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
532 SPARKMAN ST SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARTSELLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35640-3120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-773-6035
Provider Business Practice Location Address Fax Number:
256-751-4805
Provider Enumeration Date:
08/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CLINGMAN BANKS
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
256-773-6035

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  806 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 515-51761 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 510-91197 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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