Healthcare Provider Details

I. General information

NPI: 1770727414
Provider Name (Legal Business Name): CENTER HOME HEALTH CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2009
Last Update Date: 03/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607A BOLL WEEVIL CIR
ENTERPRISE AL
36330-2733
US

IV. Provider business mailing address

607A BOLL WEEVIL CIR
ENTERPRISE AL
36330-2733
US

V. Phone/Fax

Practice location:
  • Phone: 334-347-4242
  • Fax: 334-393-9226
Mailing address:
  • Phone: 334-347-4242
  • Fax: 334-393-9226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number113256
License Number StateAL

VII. Legacy identifiers

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

# 1
Identifier2119825
Identifier TypeOTHER
Identifier State
Identifier IssuerPK

VIII. Authorized Official

Name: GEORGE SHIVER
Title or Position: PRESIDENT/OWNER/PHARMACIST
Credential:
Phone: 334-347-4242