Healthcare Provider Details

I. General information

NPI: 1134254832
Provider Name (Legal Business Name): DIXIE NURSING CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 08/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

696 SILVER HILLS DR SUITE 111
PRATTVILLE AL
36066-6184
US

IV. Provider business mailing address

696 SILVER HILLS DR SUITE 111
PRATTVILLE AL
36066-6184
US

V. Phone/Fax

Practice location:
  • Phone: 334-361-0195
  • Fax: 334-361-0633
Mailing address:
  • Phone: 334-361-0195
  • Fax: 334-361-0633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number
License Number State

VIII. Authorized Official

Name: MR. JESSE M AMIS JR.
Title or Position: OWNER
Credential: PVT DUTY NURSING AG
Phone: 662-563-1275