1962409797 NPI number — GREENBRIAR AT THE ALTAMONT, LLC

Table of content: (NPI 1962409797)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962409797 NPI number — GREENBRIAR AT THE ALTAMONT, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREENBRIAR AT THE ALTAMONT, 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:
GREENBRIAR AT THE ALTAMONT, LLC
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:
1962409797
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 CORPORATE PKWY STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35242-2934
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-783-8472
Provider Business Mailing Address Fax Number:
204-783-8441

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2831 HIGHLAND AVE S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35205-1801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-323-2724
Provider Business Practice Location Address Fax Number:
205-714-3195
Provider Enumeration Date:
07/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ESTEP
Authorized Official First Name:
BARBARA
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
DIRECTOR OF REGULATORY AFFAIRS
Authorized Official Telephone Number:
205-783-8472

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  10295 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X , with the licence number: 10548 , 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: 47581308 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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