Healthcare Provider Details

I. General information

NPI: 1477196954
Provider Name (Legal Business Name): DIGNIFIED CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2019
Last Update Date: 10/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4525 SAINT STEPHENS RD
PRICHARD AL
36613-3508
US

IV. Provider business mailing address

109 OAKVIEW DR
SARALAND AL
36571-2606
US

V. Phone/Fax

Practice location:
  • Phone: 251-452-0996
  • Fax:
Mailing address:
  • Phone: 251-753-1010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY ESTRADA
Title or Position: OWNER
Credential:
Phone: 251-452-0996