1659330132 NPI number — PARKWOOD HEALTH CARE FACILITY, LLC

Table of content: (NPI 1659330132)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659330132 NPI number — PARKWOOD HEALTH CARE FACILITY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARKWOOD HEALTH CARE FACILITY, 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:
1659330132
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:
3301 STADIUM DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHENIX CITY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36867-3115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-297-0237
Provider Business Practice Location Address Fax Number:
334-297-0328
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:  12669 , 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: 4755700S , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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