Healthcare Provider Details

I. General information

NPI: 1992122709
Provider Name (Legal Business Name): STAFF MEDICAL SERVICE HOME HEALTH,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2014
Last Update Date: 03/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 NOBLE ST SUITE 101
ANNISTON AL
36201-4659
US

IV. Provider business mailing address

1200 NOBLE ST SUITE 101
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 Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number133832
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number133832
License Number StateAL

VIII. Authorized Official

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