Provider Demographics
NPI:1376615773
Name:THE EAST ALABAMA HEALTH CARE AUTHORITY
Entity Type:Organization
Organization Name:THE EAST ALABAMA HEALTH CARE AUTHORITY
Other - Org Name:OAK PARK
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 1:1365 GATEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-2834
Mailing Address - Country:US
Mailing Address - Phone:334-826-7200
Mailing Address - Fax:
Practice Address - Street 1:1365 GATEWOOD DR
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-2834
Practice Address - Country:US
Practice Address - Phone:334-826-7200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE EAST ALABAMA HEALTH CARE AUTHORITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-14
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4758150SMedicaid
AL010543OtherBLUE CROSS & BLUE SHIELD
AL4758150SMedicaid
AL4758150SMedicaid