Provider Demographics
NPI:1225457757
Name:PALLIATIVE AND SUPPORTIVE CARE ALLIANCE, INC
Entity Type:Organization
Organization Name:PALLIATIVE AND SUPPORTIVE CARE ALLIANCE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:STORMY
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:DISMUKE
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:256-302-1633
Mailing Address - Street 1:408 MARTLING RD STE A-105
Mailing Address - Street 2:
Mailing Address - City:ALBERTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35951-7208
Mailing Address - Country:US
Mailing Address - Phone:256-302-1663
Mailing Address - Fax:256-279-0534
Practice Address - Street 1:408 MARTLING RD STE A-105
Practice Address - Street 2:
Practice Address - City:ALBERTVILLE
Practice Address - State:AL
Practice Address - Zip Code:35951-7208
Practice Address - Country:US
Practice Address - Phone:256-302-1663
Practice Address - Fax:256-279-0534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-11
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-084124207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Single Specialty