Healthcare Provider Details

I. General information

NPI: 1881690154
Provider Name (Legal Business Name): HALEYVILLE HEALTH CARE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 02/15/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 11TH AVE
HALEYVILLE AL
35565-1613
US

IV. Provider business mailing address

2201 11TH AVE PO BOX 160
HALEYVILLE AL
35565-1613
US

V. Phone/Fax

Practice location:
  • Phone: 205-486-9478
  • Fax: 205-486-8393
Mailing address:
  • Phone: 205-486-9478
  • Fax: 205-486-8393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number10674
License Number StateAL

VIII. Authorized Official

Name: TRACY HOOKER
Title or Position: ADMINISTRATOR
Credential:
Phone: 205-486-9478