Provider Demographics
NPI:1144273160
Name:HOSPICE OF MONTGOMERY INC
Entity type:Organization
Organization Name:HOSPICE OF MONTGOMERY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JENILLE
Authorized Official - Middle Name:V
Authorized Official - Last Name:BALL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:334-279-6677
Mailing Address - Street 1:1111 HOLLOWAY PARK
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-1902
Mailing Address - Country:US
Mailing Address - Phone:334-279-6677
Mailing Address - Fax:334-277-2223
Practice Address - Street 1:1111 HOLLOWAY PARK
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-1902
Practice Address - Country:US
Practice Address - Phone:334-279-6677
Practice Address - Fax:334-277-2223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11724251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL010371OtherBLUE CROSS BLUE SHIELD
ALPIC1523EMedicaid
AL011523Medicare ID - Type Unspecified