1942207113 NPI number — CAPITOL HILL HEALTHCARE CENTER, INC

Table of content: (NPI 1942207113)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942207113 NPI number — CAPITOL HILL HEALTHCARE CENTER, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAPITOL HILL HEALTHCARE CENTER, INC
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:
1942207113
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/01/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
520 S HULL ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTGOMERY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36104-4610
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-834-2920
Provider Business Mailing Address Fax Number:
334-834-1145

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
520 S HULL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTGOMERY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36104-4610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-834-2920
Provider Business Practice Location Address Fax Number:
334-834-1145
Provider Enumeration Date:
07/04/2005

Additional Information

Authorized Official

Authorized Official Last Name:
WALLS
Authorized Official First Name:
EMILY
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
334-265-3900

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  08387 , 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: 010630 . This is a "BC/BS OF AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 7100049 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 012392 . This is a "BC/BS OF AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 0431541 . This is a "HEALTHSPRINGS OF AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 4757300S , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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