Healthcare Provider Details

I. General information

NPI: 1902804883
Provider Name (Legal Business Name): CAREGIVERS OF PLEASANT GROVE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 01/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 1ST AVE
PLEASANT GROVE AL
35127-1915
US

IV. Provider business mailing address

41899 HIGHWAY 195
HALEYVILLE AL
35565-7056
US

V. Phone/Fax

Practice location:
  • Phone: 205-744-8120
  • Fax: 205-744-8285
Mailing address:
  • Phone: 205-486-2558
  • Fax: 888-258-0375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number10545
License Number StateAL

VIII. Authorized Official

Name: MS. LISA A BECKMANN
Title or Position: CORPORATE ACCOUNTS MANAGER
Credential:
Phone: 205-486-2558