MEDICARE: HEALTH CARE FOR LIFE AL, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist
2	152W00000X	Optometrist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265794598
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTH CARE FOR LIFE AL, LLC

Provider Business Mailing Address
First Line	:	PO BOX 335
Second Line	:
City	:	RUSSELLVILLE
State	:	AL
Zip	:	35653-0335
Country	:	US
Telephone Number	:	205-208-9955
Fax Number	:	256-332-5403

Provider Business Practice Location Address
First Line	:	523 GANDY ST NE
Second Line	:	STE A
City	:	RUSSELLVILLE
State	:	AL
Zip	:	35653-1961
Country	:	US
Telephone Number	:	205-208-9955
Fax Number	:	256-332-5403

Authorized Official
Title or Position	:	PARTNER/MANAGING MEMBER
Name	:	DR. STUART M GREENBERG
Credential	:	O.D.
Telephone Number	:	256-324-1918

Provider Enumeration Date	:	06/12/2012
Last Update Date	:	06/10/2013

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Directions to “HEALTH CARE FOR LIFE AL, LLC ” Practice Location

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