Provider Demographics
NPI:1437309317
Name:DEATSVILLE CARE FOUNDATION, INC.
Entity Type:Organization
Organization Name:DEATSVILLE CARE FOUNDATION, INC.
Other - Org Name:RESURRECTION LIFE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MITTLEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-870-2813
Mailing Address - Street 1:65 CHARLTON PLACE
Mailing Address - Street 2:1240 COUNTY ROAD 39
Mailing Address - City:DEATSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36022
Mailing Address - Country:US
Mailing Address - Phone:334-263-0727
Mailing Address - Fax:
Practice Address - Street 1:65 CHARLTON PLACE
Practice Address - Street 2:1240 COUNTY ROAD 39
Practice Address - City:DEATSVILLE
Practice Address - State:AL
Practice Address - Zip Code:36022
Practice Address - Country:US
Practice Address - Phone:334-263-0727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-26
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL015460Medicare Oscar/Certification