Healthcare Provider Details

I. General information

NPI: 1932281615
Provider Name (Legal Business Name): TALLADEGA HEALTHCARE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 01/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 CHAFFEE ST
TALLADEGA AL
35160-2809
US

IV. Provider business mailing address

616 CHAFFEE ST
TALLADEGA AL
35160-2809
US

V. Phone/Fax

Practice location:
  • Phone: 256-362-4197
  • Fax: 256-362-0726
Mailing address:
  • Phone: 256-362-4197
  • Fax: 256-362-0726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number12681
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MS. PATTI WALLACE
Title or Position: CHAIRMAN OF THE BOARD
Credential:
Phone: 334-273-9002