Healthcare Provider Details

I. General information

NPI: 1770561268
Provider Name (Legal Business Name): CARESOUTH HHA HOLDINGS OF DOTHAN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 GRACELAND DR STE 3
DOTHAN AL
36305-7348
US

IV. Provider business mailing address

6688 N CENTRAL EXPRESSWAY SUITE 1300
DALLAS TX
75206-3950
US

V. Phone/Fax

Practice location:
  • Phone: 334-793-5758
  • Fax: 334-677-1174
Mailing address:
  • Phone: 214-239-6500
  • Fax: 214-236-6581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberN/A
License Number StateAL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier01D0696340
Identifier TypeOTHER
Identifier StateAL
Identifier IssuerCLIA
# 2
IdentifierCAR7053A
Identifier TypeMEDICAID
Identifier StateAL
Identifier Issuer

VIII. Authorized Official

Name: JULIE DIANE JOLLEY
Title or Position: EVP OF HOME HEALTH OPERATIONS
Credential:
Phone: 214-239-6500