Healthcare Provider Details

I. General information

NPI: 1952883894
Provider Name (Legal Business Name): IMPERIAL PRIMARY HEALTH & HOME CARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2018
Last Update Date: 10/26/2022
Certification Date: 10/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 S BROAD ST
MOBILE AL
36603-1121
US

IV. Provider business mailing address

451 S BROAD ST
MOBILE AL
36603-1121
US

V. Phone/Fax

Practice location:
  • Phone: 251-654-7453
  • Fax: 251-380-6973
Mailing address:
  • Phone: 251-654-7453
  • Fax: 251-380-6973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QC1800X
TaxonomyCorporate Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 8
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 9
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number1-081016
License Number StateAL

VIII. Authorized Official

Name: MRS. AMESHIA D BUSH-TAYLOR
Title or Position: NURSE PRACTITIONER
Credential: CRNP
Phone: 251-654-7453