Healthcare Provider Details

I. General information

NPI: 1013903608
Provider Name (Legal Business Name): THE CHEROKEE COUNTY HEALTH CARE AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 05/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

877 CEDAR BLUFF RD
CENTRE AL
35960-1005
US

IV. Provider business mailing address

877 CEDAR BLUFF RD
CENTRE AL
35960-1005
US

V. Phone/Fax

Practice location:
  • Phone: 256-927-5778
  • Fax: 256-927-6294
Mailing address:
  • Phone: 256-927-5778
  • Fax: 256-927-6294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number11125
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberN1001
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License NumberN1001
License Number StateAL

VIII. Authorized Official

Name: MRS. LINDA R DAVIS
Title or Position: ADMIN ASSISTANT
Credential:
Phone: 256-927-5778