Provider Demographics
NPI:1578950192
Name:SPECIAL PROFESSIONAL H/C SERVICES
Entity Type:Organization
Organization Name:SPECIAL PROFESSIONAL H/C SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBBECCA
Authorized Official - Middle Name:DAVIS
Authorized Official - Last Name:GOTHWRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-535-7074
Mailing Address - Street 1:2214 3RD AVENUE NORTH
Mailing Address - Street 2:102
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35203-3829
Mailing Address - Country:US
Mailing Address - Phone:205-538-7074
Mailing Address - Fax:205-538-5755
Practice Address - Street 1:2214 3RD AVE N
Practice Address - Street 2:102
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35203-3822
Practice Address - Country:US
Practice Address - Phone:205-538-7074
Practice Address - Fax:205-538-5755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-21
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15004490253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care