Healthcare Provider Details

I. General information

NPI: 1679532238
Provider Name (Legal Business Name): CROWNE HEALTH CARE OF MONTGOMERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 03/06/2024
Certification Date: 03/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1837 UPPER WETUMPKA RD
MONTGOMERY AL
36107-1333
US

IV. Provider business mailing address

501 WHETSTONE ST
MONROEVILLE AL
36460-2615
US

V. Phone/Fax

Practice location:
  • Phone: 334-264-8416
  • Fax: 334-264-1169
Mailing address:
  • Phone: 251-743-3609
  • Fax: 251-575-5618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number12648
License Number StateAL

VIII. Authorized Official

Name: NOEL DUNNAM
Title or Position: CFO
Credential:
Phone: 251-743-7137