Provider Demographics
NPI:1114904968
Name:THE HEALTH CARE AUTHORITY OF ELBA ALABAMA
Entity Type:Organization
Organization Name:THE HEALTH CARE AUTHORITY OF ELBA ALABAMA
Other - Org Name:ELBA GENERAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:NOLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MHA, FACHE
Authorized Official - Phone:334-897-2257
Mailing Address - Street 1:987 DRAYTON AVE
Mailing Address - Street 2:
Mailing Address - City:ELBA
Mailing Address - State:AL
Mailing Address - Zip Code:36323-1402
Mailing Address - Country:US
Mailing Address - Phone:334-897-2257
Mailing Address - Fax:334-897-1213
Practice Address - Street 1:987 DRAYTON AVE
Practice Address - Street 2:
Practice Address - City:ELBA
Practice Address - State:AL
Practice Address - Zip Code:36323-1402
Practice Address - Country:US
Practice Address - Phone:334-897-2257
Practice Address - Fax:334-897-1213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-22
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10328282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL143OtherBLUE CROSS BLUE SHIELD
ALHOS0027HMedicaid
ALHOS0027HMedicaid