MEDICARE: HOSPICE OF WEST ALABAMA, 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	251G00000X	Community Based Hospice Care Agency	10278	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
2	010497	OTHER	AL	BLUE CROSS/BLUE SHEILD

General Provider Information

NPI Number	:	1861497935
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOSPICE OF WEST ALABAMA, INC.

Provider Business Mailing Address
First Line	:	3851 LOOP RD
Second Line	:
City	:	TUSCALOOSA
State	:	AL
Zip	:	35404-5040
Country	:	US
Telephone Number	:	205-523-0101
Fax Number	:	205-523-0102

Provider Business Practice Location Address
First Line	:	3851 LOOP RD
Second Line	:
City	:	TUSCALOOSA
State	:	AL
Zip	:	35404-5040
Country	:	US
Telephone Number	:	205-523-0101
Fax Number	:	205-523-0102

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. LATRELLE PORTER BELL
Credential	:	LBSW
Telephone Number	:	205-523-0101

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	07/12/2012

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Directions to “HOSPICE OF WEST ALABAMA, INC. ” Practice Location

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