Healthcare Provider Details

I. General information

NPI: 1366565194
Provider Name (Legal Business Name): THE BETHESDA LIFE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2007
Last Update Date: 11/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 19TH STREET ENSLEY
BIRMINGHAM AL
35218-1642
US

IV. Provider business mailing address

PO BOX 8348
BIRMINGHAM AL
35218-0348
US

V. Phone/Fax

Practice location:
  • Phone: 205-788-2200
  • Fax: 205-788-2201
Mailing address:
  • Phone: 205-788-2200
  • Fax: 205-788-2201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number1020764
License Number StateAL

VIII. Authorized Official

Name: MS. BETTINA BYRD-GILES
Title or Position: COO
Credential:
Phone: 205-788-2200