=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073699898
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STATE OF ALABAMA DEPARTMENT OF PUBLIC HEALTH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2006
-----------------------------------------------------
Last Update Date | 09/13/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1801 CORPORATE DR
-----------------------------------------------------
City | OPELIKA
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36801-6861
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-745-5293
-----------------------------------------------------
Fax | 334-745-9825
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 201 MONROE ST THE RSA TOWER, SUITE 1200
-----------------------------------------------------
City | MONTGOMERY
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36104-3735
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-206-5341
-----------------------------------------------------
Fax | 334-206-5724
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | STATE HOME CARE DIRECTOR
-----------------------------------------------------
Name | GROVER T WEDGEWORTH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 334-206-5341
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------