1023061496 NPI number — CRESTWOOD HEALTHCARE LP

Table of content: (NPI 1023061496)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023061496 NPI number — CRESTWOOD HEALTHCARE LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CRESTWOOD HEALTHCARE LP
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:
1023061496
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/30/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 849007
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75284-9007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-882-3100
Provider Business Mailing Address Fax Number:
256-880-4246

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 HOSPITAL DR SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTSVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35801-6455
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-882-3100
Provider Business Practice Location Address Fax Number:
256-880-4246
Provider Enumeration Date:
05/18/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LALOR
Authorized Official First Name:
PAULA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
629-215-3953

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QL0400X , with the licence number: H4501 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: H4501 , 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: HOS010131H , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010237600 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".