Healthcare Provider Details

I. General information

NPI: 1225424765
Provider Name (Legal Business Name): THE FLAHERTY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2015
Last Update Date: 06/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 RIDGEMONT AVE
NORTHPORT AL
35473-1623
US

IV. Provider business mailing address

4301 RIDGEMONT AVE
NORTHPORT AL
35473-1623
US

V. Phone/Fax

Practice location:
  • Phone: 205-534-0847
  • Fax:
Mailing address:
  • Phone: 205-534-0847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberR009024294
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number323851
License Number StateAL

VIII. Authorized Official

Name: RICHARD M FLAHERTY
Title or Position: OWNER
Credential:
Phone: 205-534-0847