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General NPI Number Information
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NPI Number | 1841219896
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Entity Type | Organization
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Legal Business Name | PRIVATE DUTY NURSING SERVICE, INX
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Dates
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Enumeration Date | 07/19/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1530 WOLVERINE DR SE
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City | DECATUR
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State | AL
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Zip | 35601-4949
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Country | US
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Telephone | 256-355-1811
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Fax | 256-355-8419
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Provider Business Mailing Address
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Address Line | 1530 WOLVERINE DR SE
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City | DECATUR
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State | AL
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Zip | 35601-4949
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Country | US
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Telephone | 256-355-1811
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Fax | 256-355-8419
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MRS. NITA F. WALLACE
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Credential |
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Telephone | 256-355-1811
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 04825
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License Number State | AL
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