1962913350 NPI number — BALDWIN COUNTY TRANSITIONAL CARE LLC

Table of content: (NPI 1962913350)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962913350 NPI number — BALDWIN COUNTY TRANSITIONAL CARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BALDWIN COUNTY TRANSITIONAL CARE 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:
1962913350
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/12/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
08/23/2018
NPI Reactivation Date:
09/11/2018

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 587
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRHOPE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36533-0587
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-300-0025
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
77 MAGNOLIA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRHOPE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36532-2540
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-300-0025
Provider Business Practice Location Address Fax Number:
855-292-8226
Provider Enumeration Date:
10/12/2017

Additional Information

Authorized Official

Authorized Official Last Name:
REEVES
Authorized Official First Name:
SABRINA
Authorized Official Middle Name:
Authorized Official Title or Position:
CO-OWNER
Authorized Official Telephone Number:
251-300-0025

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363AM0700X , with the licence number: PA1092 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 51205740 . This is a "BCBS-AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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