1154380632 NPI number — CROWNE HEALTH CARE OF MOBILE, 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 1154380632 NPI number — CROWNE HEALTH CARE OF MOBILE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CROWNE HEALTH CARE OF MOBILE, 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:
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:
1154380632
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/06/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 WHETSTONE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONROEVILLE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36460-2615
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-743-3609
Provider Business Mailing Address Fax Number:
251-575-5618

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
954 NAVCO RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOBILE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36605-2413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-473-8684
Provider Business Practice Location Address Fax Number:
251-471-6329
Provider Enumeration Date:
03/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DUNNAM
Authorized Official First Name:
NOEL
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
251-743-7137

Provider Taxonomy Codes

  • Taxonomy code: 313M00000X , with the licence number:  12633 , 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: 4754460S , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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