1194927046 NPI number — CONTINUOUS CARE SERVICES ALABAMA, LLC

Table of content: (NPI 1194927046)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194927046 NPI number — CONTINUOUS CARE SERVICES ALABAMA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONTINUOUS CARE SERVICES ALABAMA, 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:
1194927046
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/12/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
545 MAINSTREAM DR STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37228-1213
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-259-2772
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 OXMOOR BLVD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35209-5953
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-941-3240
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DONOVAN
Authorized Official First Name:
BOB
Authorized Official Middle Name:
F
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
503-586-7147

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  182576 , 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: 182576 . This is a "BUSINESS LICENSE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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