Healthcare Provider Details

I. General information

NPI: 1003806092
Provider Name (Legal Business Name): JEFFERSON COUNTY COMMISSION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 10/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N PINE HILL RD
BIRMINGHAM AL
35217-1215
US

IV. Provider business mailing address

200 N PINE HILL RD
BIRMINGHAM AL
35217-1215
US

V. Phone/Fax

Practice location:
  • Phone: 205-849-2352
  • Fax: 205-849-2371
Mailing address:
  • Phone: 205-849-2352
  • Fax: 205-849-2371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number11181
License Number StateAL

VIII. Authorized Official

Name: MR. DERRICK WILLIAMS
Title or Position: DIRECTOR
Credential: LNHA
Phone: 205-849-2352