Provider Demographics
NPI:1558752949
Name:MY 180 HEALTH, LLC
Entity Type:Organization
Organization Name:MY 180 HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLTON
Authorized Official - Middle Name:CLAUDE
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:256-226-5789
Mailing Address - Street 1:1618 SLAUGHTER ROAD
Mailing Address - Street 2:SUITE C
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758
Mailing Address - Country:US
Mailing Address - Phone:256-226-5789
Mailing Address - Fax:
Practice Address - Street 1:1618 SLAUGHTER ROAD
Practice Address - Street 2:MADISON
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758
Practice Address - Country:US
Practice Address - Phone:286-226-5789
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-07
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2000X, 261QR0400X
AL261QP2000X, 261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation