MEDICARE: C & G HEALTHCARE SERVICES, INC.

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	314000000X	Skilled Nursing Facility	10562	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811986656
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	C & G HEALTHCARE SERVICES, INC.

Provider Business Mailing Address
First Line	:	6450 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	:	6450 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	:	BUSINESS OFFICE MANAGER
Name	:	MRS. DEBORAH W. DOSS
Credential	:
Telephone Number	:	205-477-6161

Provider Enumeration Date	:	10/14/2005
Last Update Date	:	09/25/2012

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