Healthcare Provider Details

I. General information

NPI: 1851487656
Provider Name (Legal Business Name): CRENSHAW COUNTY HEALTH CARE AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/20/2020
Certification Date: 07/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 HOSPITAL CIR
LUVERNE AL
36049-7329
US

IV. Provider business mailing address

101 HOSPITAL CIR
LUVERNE AL
36049-7329
US

V. Phone/Fax

Practice location:
  • Phone: 334-335-1209
  • Fax: 334-335-1208
Mailing address:
  • Phone: 334-335-1209
  • Fax: 334-335-1208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL ANDREW KIMBRO
Title or Position: CHAIRMAN
Credential:
Phone: 334-335-3374