Healthcare Provider Details

I. General information

NPI: 1487765962
Provider Name (Legal Business Name): CAMILLE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 03/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 OLD SHELL RD
MOBILE AL
36608-1319
US

IV. Provider business mailing address

3900 OLD SHELL RD
MOBILE AL
36608-1319
US

V. Phone/Fax

Practice location:
  • Phone: 251-342-5623
  • Fax: 251-342-6938
Mailing address:
  • Phone: 251-342-5623
  • Fax: 251-342-6938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number12638
License Number StateAL

VIII. Authorized Official

Name: ANGELA P HART
Title or Position: ADMINISTRATOR
Credential:
Phone: 251-342-5623