Healthcare Provider Details

I. General information

NPI: 1720552284
Provider Name (Legal Business Name): WYNNTER SPRINGS PRIVATE HOME CARE, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2019
Last Update Date: 03/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

956 6TH ST
PLEASANT GROVE AL
35127-1506
US

IV. Provider business mailing address

PO BOX 564
PLEASANT GROVE AL
35127-0564
US

V. Phone/Fax

Practice location:
  • Phone: 205-434-1886
  • Fax:
Mailing address:
  • Phone: 205-434-1886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MRS. TANYA JOHNSON JONES
Title or Position: ADMINISTRATOR
Credential:
Phone: 205-434-1886