Healthcare Provider Details

I. General information

NPI: 1568476240
Provider Name (Legal Business Name): CENTRE HOSPITAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 04/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 NORTHWOOD DR
CENTRE AL
35960-1023
US

IV. Provider business mailing address

PO BOX 277503
ATLANTA GA
30384-7503
US

V. Phone/Fax

Practice location:
  • Phone: 256-927-5531
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number012867
License Number StateAL

VIII. Authorized Official

Name: TARA P RICHARDSON
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 615-221-3672