Provider Demographics
NPI:1073791372
Name:CENTRAL ALABAMA MEDICAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:CENTRAL ALABAMA MEDICAL ASSOCIATES, LLC
Other - Org Name:CHILTON MEDICAL CENTER HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HOME HEALTH ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:J
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-280-4663
Mailing Address - Street 1:1010 LAY DAM ROAD
Mailing Address - Street 2:
Mailing Address - City:CLANTON
Mailing Address - State:AL
Mailing Address - Zip Code:35046-1920
Mailing Address - Country:US
Mailing Address - Phone:205-280-4663
Mailing Address - Fax:205-280-3489
Practice Address - Street 1:1010 LAY DAM RD
Practice Address - Street 2:
Practice Address - City:CLANTON
Practice Address - State:AL
Practice Address - Zip Code:35045-2306
Practice Address - Country:US
Practice Address - Phone:205-280-4663
Practice Address - Fax:205-280-3489
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUNLINK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-08
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1284-HHA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-93666OtherB/C B/S
ALCHI7107AMedicaid
AL017107Medicare Oscar/Certification