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General NPI Number Information
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NPI Number | 1649389610
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Entity Type | Organization
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Legal Business Name | THE HEALTH CARE AUTHORITY OF THE CITY OF ENTERPRISE, INC.
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 04/17/2023
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Provider Practice Location Address
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Address Line | 300 PLAZA DR
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City | ENTERPRISE
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State | AL
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Zip | 36330-3311
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Country | US
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Telephone | 334-347-9541
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Fax | 334-347-5070
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Provider Business Mailing Address
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Address Line | 300 PLAZA DR
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City | ENTERPRISE
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State | AL
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Zip | 36330-3311
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Country | US
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Telephone | 334-347-9541
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Fax | 334-347-5070
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. WESLEY M. AVERETT
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Credential |
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Telephone | 334-347-9541
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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 | N1602
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number | N1602
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License Number State | AL
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Taxonomy #3
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | N1602
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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 | 0601900001
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Identifier Type | OTHER
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Identifier State | AL
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Identifier Issuer | DME SUPPLIER
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Identifier #2
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Identifier Code | 4753200S
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Identifier Type | MEDICAID
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Identifier State | AL
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Identifier Issuer |
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Identifier #3
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Identifier Code | 010605
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Identifier Type | OTHER
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Identifier State | AL
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Identifier Issuer | BLUE CROSS/BLUE SHIELD
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Proprietary Identifiers Ever Reported
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Identifier #1
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Identifier Code | 010605
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Identifier Type | OTHER
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Identifier State | AL
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Identifier Issuer | BLUE CROSS/BLUE SHIELD
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Identifier #2
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Identifier Code | 0601900001
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Identifier Type | OTHER
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Identifier State | AL
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Identifier Issuer | DME SUPPLIER
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Identifier #3
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Identifier Code | 4753200S
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Identifier Type | MEDICAID
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Identifier State | AL
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Identifier Issuer |
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