Healthcare Provider Details

I. General information

NPI: 1205502929
Provider Name (Legal Business Name): MENDING HEARTS ON WHEELS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2021
Last Update Date: 08/26/2021
Certification Date: 08/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3477 CROSS CREEK DR
MONTGOMERY AL
36116-3654
US

IV. Provider business mailing address

3477 CROSS CREEK DR
MONTGOMERY AL
36116-3654
US

V. Phone/Fax

Practice location:
  • Phone: 334-462-8931
  • Fax: 334-281-9052
Mailing address:
  • Phone: 334-462-8931
  • Fax: 334-281-9052

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: EARNESTINE POLLARD ALEXANDER
Title or Position: REGISTERED NURSE/OWNER
Credential:
Phone: 334-462-8931