Healthcare Provider Details

I. General information

NPI: 1609157254
Provider Name (Legal Business Name): STAFF MEDICAL SERVICE HOME HEALTH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 NOBLE ST SUITE101
ANNISTON AL
36201-4659
US

IV. Provider business mailing address

1200 NOBLE ST SUITE101
ANNISTON AL
36201-4659
US

V. Phone/Fax

Practice location:
  • Phone: 256-405-4022
  • Fax: 256-365-2060
Mailing address:
  • Phone: 256-405-4022
  • Fax: 256-365-2060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251T00000X
TaxonomyPACE Provider Organization
License Number3943
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateAL
# 4
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. RUBY STOCKDALE
Title or Position: PRESIDENT OF BOARD OF DIRECTORS
Credential:
Phone: 256-405-4022