Healthcare Provider Details

I. General information

NPI: 1194896712
Provider Name (Legal Business Name): BETHANY HOUSE OF EAST ALABAMA MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1171 GATEWOOD DR
AUBURN AL
36830-1817
US

IV. Provider business mailing address

1171 GATEWOOD DR
AUBURN AL
36830-1817
US

V. Phone/Fax

Practice location:
  • Phone: 334-826-0032
  • Fax: 334-826-1602
Mailing address:
  • Phone: 334-826-0032
  • Fax: 334-826-1602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License Number11693
License Number StateAL

VIII. Authorized Official

Name: MR. CAROL P MURPHEY
Title or Position: DIRECTOR
Credential: R.N.
Phone: 334-826-1899