Healthcare Provider Details

I. General information

NPI: 1952470205
Provider Name (Legal Business Name): GREENE COUNTY HOSPITAL HOME HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 11/22/2022
Certification Date: 11/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 WILSON AVE
EUTAW AL
35462
US

IV. Provider business mailing address

509 WILSON AVE
EUTAW AL
35462-1064
US

V. Phone/Fax

Practice location:
  • Phone: 205-372-3299
  • Fax: 205-372-3316
Mailing address:
  • Phone: 205-372-3299
  • Fax: 205-372-3316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. MARCIA PUGH
Title or Position: ADMINISTRATOR
Credential:
Phone: 205-372-3388