MEDICARE: CAREGIVERS OF PLEASANT GROVE 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	10545	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	:	1902804883
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAREGIVERS OF PLEASANT GROVE INC

Provider Business Mailing Address
First Line	:	41899 HIGHWAY 195
Second Line	:
City	:	HALEYVILLE
State	:	AL
Zip	:	35565-7056
Country	:	US
Telephone Number	:	205-486-2558
Fax Number	:	888-258-0375

Provider Business Practice Location Address
First Line	:	700 1ST AVE
Second Line	:
City	:	PLEASANT GROVE
State	:	AL
Zip	:	35127-1915
Country	:	US
Telephone Number	:	205-744-8120
Fax Number	:	205-744-8285

Authorized Official
Title or Position	:	CORPORATE ACCOUNTS MANAGER
Name	:	MS. LISA A BECKMANN
Credential	:
Telephone Number	:	205-486-2558

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	01/31/2011

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