MEDICARE: RESURRECTION CATHOLIC MISSIONS OF THE SOUTH, INC

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	3140N1450X	Pediatric Skilled Nursing Facility	12652	AL
2	314000000X	Skilled Nursing Facility	12471	AL

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689750283
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESURRECTION CATHOLIC MISSIONS OF THE SOUTH, INC

Provider Business Mailing Address
First Line	:	2815 FORBES DR
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36110-1307
Country	:	US
Telephone Number	:	334-263-4221
Fax Number	:	334-263-4999

Provider Business Practice Location Address
First Line	:	2815 FORBES DR
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36110-1307
Country	:	US
Telephone Number	:	334-263-4221
Fax Number	:	334-263-4999

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MR. GRANT H. HAYGOOD
Credential	:	CPA
Telephone Number	:	334-230-1964

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	09/11/2025

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