Healthcare Provider Details

I. General information

NPI: 1104530963
Provider Name (Legal Business Name): THE BIBB COUNTY HEALTH CARE AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2023
Last Update Date: 01/06/2023
Certification Date: 01/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 PIERSON AVE
CENTREVILLE AL
35042-2918
US

IV. Provider business mailing address

208 PIERSON AVE
CENTREVILLE AL
35042-2918
US

V. Phone/Fax

Practice location:
  • Phone: 205-926-3277
  • Fax:
Mailing address:
  • Phone: 205-926-3281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: HEATHER DESMOND
Title or Position: VICE-PRESIDENT/CFO
Credential:
Phone: 205-926-3281