Healthcare Provider Details

I. General information

NPI: 1528513801
Provider Name (Legal Business Name): FRUIT OF THE SPIRIT HOME HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2016
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5211 JONES RD N
THEODORE AL
36582-2113
US

IV. Provider business mailing address

5211 JONES RD N
THEODORE AL
36582-2113
US

V. Phone/Fax

Practice location:
  • Phone: 251-623-3161
  • Fax: 251-644-7601
Mailing address:
  • Phone: 251-623-3161
  • Fax: 251-644-7601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateAL

VIII. Authorized Official

Name: PHYLLIS JOHNSON
Title or Position: OWNER
Credential:
Phone: 251-623-3161