Healthcare Provider Details

I. General information

NPI: 1477506970
Provider Name (Legal Business Name): HUNTSVILLE SENIOR SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 04/18/2025
Certification Date: 04/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2004 MAX LUTHER DR NW
HUNTSVILLE AL
35810-3800
US

IV. Provider business mailing address

2061 POOLE DR NW
HUNTSVILLE AL
35810-3843
US

V. Phone/Fax

Practice location:
  • Phone: 256-852-0033
  • Fax: 256-859-7700
Mailing address:
  • Phone: 256-852-0033
  • Fax: 256-859-7700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberN4505
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code3140N1450X
TaxonomyPediatric Skilled Nursing Facility
License Number12610
License Number StateAL

VIII. Authorized Official

Name: VICKI L NESMITH
Title or Position: ADMINISTRATOR
Credential:
Phone: 256-852-0033