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General NPI Number Information
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NPI Number | 1578950192
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Entity Type | Organization
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Legal Business Name | SPECIAL PROFESSIONAL H/C SERVICES
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Dates
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Enumeration Date | 04/21/2015
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Last Update Date | 04/21/2015
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Provider Practice Location Address
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Address Line | 2214 3RD AVE N 102
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City | BIRMINGHAM
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State | AL
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Zip | 35203-3822
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Country | US
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Telephone | 205-538-7074
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Fax | 205-538-5755
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Provider Business Mailing Address
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Address Line | 2214 3RD AVENUE NORTH 102
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City | BIRMINGHAM
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State | AL
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Zip | 35203-3829
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Country | US
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Telephone | 205-538-7074
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Fax | 205-538-5755
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Authorized Official
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Title or Position | ADMINISTRATOR/CEO
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Name | MRS. REBBECCA DAVIS GOTHWRIGHT
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Credential |
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Telephone | 205-535-7074
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 15004490
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License Number State | AL
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