1245214006 NPI number — EAST ALABAMA HOMEMED LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245214006 NPI number — EAST ALABAMA HOMEMED LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAST ALABAMA HOMEMED LLC
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:
6
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:
1245214006
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/15/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4043
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OPELIKA
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36803-4043
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-741-7410
Provider Business Mailing Address Fax Number:
334-742-0032

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1908 PEPPERELL PKWY
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
OPELIKA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36801-5473
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-741-7410
Provider Business Practice Location Address Fax Number:
334-742-0032
Provider Enumeration Date:
12/05/2005

Additional Information

Authorized Official

Authorized Official Last Name:
STOUTE
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
BRETT
Authorized Official Title or Position:
CHIEF COMPLIANCE OFFICER
Authorized Official Telephone Number:
337-500-1977

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X , with the licence number:  557 , 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)





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