=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447992201
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CRIMSON VILLAGE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/12/2022
-----------------------------------------------------
Last Update Date | 04/12/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1410 18TH AVE E
-----------------------------------------------------
City | TUSCALOOSA
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35404-3950
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-553-1500
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1251 MCFARLAND BLVD NE
-----------------------------------------------------
City | TUSCALOOSA
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35406-2232
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-523-7483
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. RAMESH PERAMSETTY
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 205-632-6699
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------