Healthcare Provider Details

I. General information

NPI: 1689750283
Provider Name (Legal Business Name): RESURRECTION CATHOLIC MISSIONS OF THE SOUTH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2815 FORBES DR
MONTGOMERY AL
36110-1307
US

IV. Provider business mailing address

2815 FORBES DR
MONTGOMERY AL
36110-1307
US

V. Phone/Fax

Practice location:
  • Phone: 334-263-4221
  • Fax: 334-263-4999
Mailing address:
  • Phone: 334-263-4221
  • Fax: 334-263-4999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number12471
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code3140N1450X
TaxonomyPediatric Skilled Nursing Facility
License Number12652
License Number StateAL

VIII. Authorized Official

Name: MR. GRANT H. HAYGOOD
Title or Position: CHIEF FINANCIAL OFFICER
Credential: CPA
Phone: 334-230-1964