1760900294 NPI number — MONTGOMERY AUBURN HOMECARE LLC

Table of content: (NPI 1760900294)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760900294 NPI number — MONTGOMERY AUBURN HOMECARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MONTGOMERY AUBURN HOMECARE 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:
VISITING ANGELS
Provider Other Organization Name Type Code:
3
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:
1760900294
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2569 BELL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTGOMERY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36117-4369
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-245-6390
Provider Business Mailing Address Fax Number:
334-245-6535

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2569 BELL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTGOMERY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-245-6390
Provider Business Practice Location Address Fax Number:
334-245-6535
Provider Enumeration Date:
09/05/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GIBSON
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
334-322-9726

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: NONE . This is a "NONE" identifier . This identifiers is of the category "OTHER".