Healthcare Provider Details

I. General information

NPI: 1144317090
Provider Name (Legal Business Name): GENEVA COUNTY HEALTHCARE AUTHORITY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 04/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 W MAPLE AVE
GENEVA AL
36340-1642
US

IV. Provider business mailing address

1200 W MAPLE AVE
GENEVA AL
36340-1642
US

V. Phone/Fax

Practice location:
  • Phone: 334-684-3655
  • Fax:
Mailing address:
  • Phone: 334-684-3655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number4772
License Number StateAL

VIII. Authorized Official

Name: MRS. JANETTE SCROGGINS
Title or Position: ADMINISTRATOR
Credential:
Phone: 334-684-3655