1902804883 NPI number — CAREGIVERS OF PLEASANT GROVE INC

Table of content: (NPI 1902804883)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902804883 NPI number — CAREGIVERS OF PLEASANT GROVE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAREGIVERS OF PLEASANT GROVE 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:
CONSULT AMERICA COTTAGE HILLS INC
Provider Other Organization Name Type Code:
4
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:
1902804883
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/31/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
41899 HIGHWAY 195
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HALEYVILLE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35565-7056
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-486-2558
Provider Business Mailing Address Fax Number:
888-258-0375

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 1ST AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLEASANT GROVE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35127-1915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-744-8120
Provider Business Practice Location Address Fax Number:
205-744-8285
Provider Enumeration Date:
07/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BECKMANN
Authorized Official First Name:
LISA
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CORPORATE ACCOUNTS MANAGER
Authorized Official Telephone Number:
205-486-2558

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  10545 , 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: 4757280S , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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