MEDICARE: BALL HEALTHCARE DALLAS 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	314000000X	Skilled Nursing Facility	12522	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	:	1932112430
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BALL HEALTHCARE DALLAS LLC

Provider Business Mailing Address
First Line	:	1 SOUTHERN WAY
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36619-1210
Country	:	US
Telephone Number	:	251-433-9801
Fax Number	:	251-433-9807

Provider Business Practice Location Address
First Line	:	2911 EARL GOODWIN PKWY
Second Line	:
City	:	SELMA
State	:	AL
Zip	:	36703-2825
Country	:	US
Telephone Number	:	334-875-1868
Fax Number	:	334-875-6650

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. ARMELIA K OLIVER
Credential	:
Telephone Number	:	334-875-1868

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	03/31/2016

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