Provider Demographics
NPI:1164847596
Name:THE EAST ALABAMA HEALTH CARE AUTHORITY
Entity Type:Organization
Organization Name:THE EAST ALABAMA HEALTH CARE AUTHORITY
Other - Org Name:EAMC - LANIER NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-528-1310
Mailing Address - Street 1:4800 48TH ST
Mailing Address - Street 2:
Mailing Address - City:VALLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36854-3666
Mailing Address - Country:US
Mailing Address - Phone:334-756-1401
Mailing Address - Fax:334-756-9192
Practice Address - Street 1:4800 48TH ST
Practice Address - Street 2:
Practice Address - City:VALLEY
Practice Address - State:AL
Practice Address - Zip Code:36854-3666
Practice Address - Country:US
Practice Address - Phone:334-756-1401
Practice Address - Fax:334-756-9192
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE EAST ALABAMA HEALTH CARE AUTHORITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-02-21
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11731313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL01-5045Medicare UPIN