Provider Demographics
NPI:1225049828
Name:SOUTHERN RURAL HEALTH CARE CONSORTIUM
Entity Type:Organization
Organization Name:SOUTHERN RURAL HEALTH CARE CONSORTIUM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-332-1631
Mailing Address - Street 1:PO BOX 970
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35653-0970
Mailing Address - Country:US
Mailing Address - Phone:256-332-1631
Mailing Address - Fax:256-332-4600
Practice Address - Street 1:508 SAINT CLAIR ST SE
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AL
Practice Address - Zip Code:35653-2720
Practice Address - Country:US
Practice Address - Phone:256-332-1631
Practice Address - Fax:256-332-4600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALSOU7017Medicaid
AL017017Medicare Oscar/Certification