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General NPI Number Information
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NPI Number | 1609958206
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Entity Type | Organization
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Legal Business Name | ALBERTVILLE HEALTHCARE CENTER, INC.
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Dates
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Enumeration Date | 10/20/2006
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Last Update Date | 01/11/2012
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Provider Practice Location Address
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Address Line | 750 AL HIGHWAY 75 N
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City | ALBERTVILLE
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State | AL
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Zip | 35951-4014
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Country | US
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Telephone | 256-878-1398
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Fax | 256-878-6949
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Provider Business Mailing Address
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Address Line | 750 AL HIGHWAY 75 N
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City | ALBERTVILLE
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State | AL
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Zip | 35951-4014
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Country | US
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Telephone | 256-878-1398
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Fax | 256-878-6949
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Authorized Official
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Title or Position | CHAIRMAN OF THE BOARD
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Name | MRS. PATTI WALLACE
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Credential |
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Telephone | 334-273-9002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 12623
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License Number State | AL
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Legacy Identifiers
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Identifier #1
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Identifier Code | 47-51240S
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Identifier Type | MEDICAID
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Identifier State | AL
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Identifier Issuer |
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Proprietary Identifiers Ever Reported
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Identifier #1
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Identifier Code | 47-51240S
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Identifier Type | MEDICAID
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Identifier State | AL
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Identifier Issuer |
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