Healthcare Provider Details

I. General information

NPI: 1881939510
Provider Name (Legal Business Name): HUBBARD FAMILY HOME HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2012
Last Update Date: 12/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

904 23RD CT NW
BIRMINGHAM AL
35215-3154
US

IV. Provider business mailing address

904 23RD CT NW
BIRMINGHAM AL
35215-3154
US

V. Phone/Fax

Practice location:
  • Phone: 205-538-5448
  • Fax: 205-854-3304
Mailing address:
  • Phone: 205-538-5448
  • Fax: 205-854-3304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License NumberLIC20T01V01
License Number StateAL

VIII. Authorized Official

Name: MRS. CORA ELIZABETH HUBBARD
Title or Position: REGISTERED NURSE
Credential: RN
Phone: 205-538-5448