Provider Demographics
NPI:1518956424
Name:LITTLE SISTERS OF THE POOR HOME FOR THE AGED INC
Entity Type:Organization
Organization Name:LITTLE SISTERS OF THE POOR HOME FOR THE AGED INC
Other - Org Name:SACRED HEART HOME
Other - Org Type:Other Name
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:GINGER
Authorized Official - Middle Name:
Authorized Official - Last Name:LYNDALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-476-6335
Mailing Address - Street 1:1655 MCGILL AVE
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36604-1218
Mailing Address - Country:US
Mailing Address - Phone:251-476-6335
Mailing Address - Fax:251-478-6519
Practice Address - Street 1:1655 MCGILL AVE
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36604-1218
Practice Address - Country:US
Practice Address - Phone:251-476-6335
Practice Address - Fax:251-478-6519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-14
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL09678310400000X
AL09684310500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL010590OtherBLUE CROSS BLUE SHIELD
AL4754740SMedicaid
AL4754740SMedicaid
AL010590OtherBLUE CROSS BLUE SHIELD