MEDICARE: BALL MANAGEMENT LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	12743	AL

General Provider Information

NPI Number	:	1447432901
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BALL MANAGEMENT LLC

Provider Business Mailing Address
First Line	:	6440 OLD TUSCALOOSA HWY
Second Line	:
City	:	MC CALLA
State	:	AL
Zip	:	35111-3606
Country	:	US
Telephone Number	:	205-477-6161
Fax Number	:	205-477-5566

Provider Business Practice Location Address
First Line	:	6440 OLD TUSCALOOSA HWY
Second Line	:
City	:	MC CALLA
State	:	AL
Zip	:	35111-3606
Country	:	US
Telephone Number	:	205-477-6161
Fax Number	:	205-477-5566

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	MR. GARY VANN BALL
Credential	:
Telephone Number	:	205-477-6161

Provider Enumeration Date	:	11/27/2007
Last Update Date	:	03/13/2008

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