Healthcare Provider Details

I. General information

NPI: 1710391206
Provider Name (Legal Business Name): PACK HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2014
Last Update Date: 06/25/2024
Certification Date: 11/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 12TH ST N
BIRMINGHAM AL
35203-1537
US

IV. Provider business mailing address

110 12TH ST N
BIRMINGHAM AL
35203-1537
US

V. Phone/Fax

Practice location:
  • Phone: 855-255-2362
  • Fax:
Mailing address:
  • Phone: 855-255-2362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State

VIII. Authorized Official

Name: LEAH D TIMMERMAN
Title or Position: SR VICE PRESIDENT
Credential:
Phone: 804-874-0505