Provider Demographics
NPI:1487843793
Name:LAWLEY DRUG & MEDICAL HOSPICE, LLC
Entity Type:Organization
Organization Name:LAWLEY DRUG & MEDICAL HOSPICE, LLC
Other - Org Name:LAWLEY PREMIER HOSPICE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:LAWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-413-4473
Mailing Address - Street 1:1250 HIGHWAY 77
Mailing Address - Street 2:
Mailing Address - City:SOUTHSIDE
Mailing Address - State:AL
Mailing Address - Zip Code:35907-0405
Mailing Address - Country:US
Mailing Address - Phone:256-413-4473
Mailing Address - Fax:256-413-7358
Practice Address - Street 1:1250 HIGHWAY 77
Practice Address - Street 2:
Practice Address - City:SOUTHSIDE
Practice Address - State:AL
Practice Address - Zip Code:35907-0405
Practice Address - Country:US
Practice Address - Phone:256-413-4473
Practice Address - Fax:256-413-7358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL011670Medicare Oscar/Certification