Healthcare Provider Details

I. General information

NPI: 1265624662
Provider Name (Legal Business Name): CASCADE HEALTH AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2007
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1311 DECATUR HWY
FULTONDALE AL
35068-1737
US

IV. Provider business mailing address

1311 DECATUR HWY
FULTONDALE AL
35068-1737
US

V. Phone/Fax

Practice location:
  • Phone: 205-841-6737
  • Fax:
Mailing address:
  • Phone: 205-841-6737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number205732829
License Number StateAL

VIII. Authorized Official

Name: DR. GINA MARIE NELSON
Title or Position: PRESIDENT/OWNER
Credential: MD
Phone: 205-841-6737