Healthcare Provider Details

I. General information

NPI: 1962913350
Provider Name (Legal Business Name): BALDWIN COUNTY TRANSITIONAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2017
Last Update Date: 09/12/2019
Certification Date:
Deactivation Date: 08/23/2018
Reactivation Date: 09/11/2018

III. Provider practice location address

77 MAGNOLIA AVE
FAIRHOPE AL
36532-2540
US

IV. Provider business mailing address

PO BOX 587
FAIRHOPE AL
36533-0587
US

V. Phone/Fax

Practice location:
  • Phone: 251-300-0025
  • Fax: 855-292-8226
Mailing address:
  • Phone: 251-300-0025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA1092
License Number StateAL

VIII. Authorized Official

Name: SABRINA REEVES
Title or Position: CO-OWNER
Credential: PA-C
Phone: 251-300-0025