Healthcare Provider Details

I. General information

NPI: 1134111081
Provider Name (Legal Business Name): DHS OF BLOUNT COUNTY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 ELLEN ST
ONEONTA AL
35121-2720
US

IV. Provider business mailing address

212 ELLEN ST P.O. BOX 698
ONEONTA AL
35121-2720
US

V. Phone/Fax

Practice location:
  • Phone: 205-625-3520
  • Fax: 205-625-3680
Mailing address:
  • Phone: 205-625-3520
  • Fax: 205-625-3680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number10468
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number StateTN

VIII. Authorized Official

Name: MRS. CAREN SUE JOHNSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 205-625-3520