1295275790 NPI number — CREST HOME HEALTHCARE OF ALABAMA

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 1295275790 NPI number — CREST HOME HEALTHCARE OF ALABAMA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CREST HOME HEALTHCARE OF ALABAMA
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:
1295275790
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/02/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2100 SOUTHBRIDGE PKWY
Provider Second Line Business Mailing Address:
691
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35209-1302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-414-7000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2100 SOUTHBRIDGE PKWY
Provider Second Line Business Practice Location Address:
691
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35209-1302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-414-7000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/02/2017

Additional Information

Authorized Official

Authorized Official Last Name:
CARPENTER
Authorized Official First Name:
YOLANDA
Authorized Official Middle Name:
GAIL
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
205-243-0859

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  17018973 , 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)





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