Provider Demographics
NPI:1346279114
Name:DADEVILLE HEALTHCARE CENTER LLC
Entity Type:Organization
Organization Name:DADEVILLE HEALTHCARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMISSIONS BOOKKEEPER
Authorized Official - Prefix:
Authorized Official - First Name:VICKY
Authorized Official - Middle Name:
Authorized Official - Last Name:STEPHENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-825-9244
Mailing Address - Street 1:PO BOX 97
Mailing Address - Street 2:
Mailing Address - City:DADEVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36853-0097
Mailing Address - Country:US
Mailing Address - Phone:256-825-9244
Mailing Address - Fax:256-825-9964
Practice Address - Street 1:351 N EAST ST
Practice Address - Street 2:
Practice Address - City:DADEVILLE
Practice Address - State:AL
Practice Address - Zip Code:36853-1517
Practice Address - Country:US
Practice Address - Phone:256-825-9244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12685314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4756000SMedicaid
AL47560005Medicaid