MEDICARE: STATE OF ALABAMA DEPARTMENT OF PUBLIC HEALTH

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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1841371762
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STATE OF ALABAMA DEPARTMENT OF PUBLIC HEALTH

Provider Business Mailing Address
First Line	:	201 MONROE ST
Second Line	:	THE RSA TOWER, SUITE1200
City	:	MONTGOMERY
State	:	AL
Zip	:	36104-3735
Country	:	US
Telephone Number	:	334-206-5341
Fax Number	:	334-206-5985

Provider Business Practice Location Address
First Line	:	3060 MOBILE HWY
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36130-0001
Country	:	US
Telephone Number	:	334-293-6525
Fax Number	:	334-293-6402

Authorized Official
Title or Position	:	STATE HOME CARE DIRECTOR
Name	:	GROVER T WEDGEWORTH
Credential	:
Telephone Number	:	334-206-5341

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	10/22/2009

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