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General NPI Number Information
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NPI Number | 1972509453
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Entity Type | Organization
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Legal Business Name | RESURRECTION LIFE CENTER
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Dates
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Enumeration Date | 06/21/2005
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1240 COUNTY ROAD 39
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City | DEATSVILLE
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State | AL
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Zip | 36022-2536
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Country | US
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Telephone | 334-263-0618
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Fax | 334-230-2056
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Provider Business Mailing Address
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Address Line | 1240 COUNTY ROAD 39
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City | DEATSVILLE
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State | AL
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Zip | 36022-2536
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Country | US
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Telephone | 334-263-0618
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Fax | 334-230-2056
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MANUEL WILLIAMS
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Credential | REV. C.R.
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Telephone | 334-263-4221
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State | AL
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