Provider Demographics
NPI:1609157254
Name:STAFF MEDICAL SERVICE HOME HEALTH, INC
Entity Type:Organization
Organization Name:STAFF MEDICAL SERVICE HOME HEALTH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF BOARD OF DIRECTORS
Authorized Official - Prefix:MS
Authorized Official - First Name:RUBY
Authorized Official - Middle Name:
Authorized Official - Last Name:STOCKDALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-405-4022
Mailing Address - Street 1:1200 NOBLE ST
Mailing Address - Street 2:SUITE101
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36201-4659
Mailing Address - Country:US
Mailing Address - Phone:256-405-4022
Mailing Address - Fax:256-365-2060
Practice Address - Street 1:1200 NOBLE ST
Practice Address - Street 2:SUITE101
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36201-4659
Practice Address - Country:US
Practice Address - Phone:256-405-4022
Practice Address - Fax:256-365-2060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3943251T00000X
253Z00000X
AL261QA0600X, 385HR2065X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL04111912OtherMEDICAID WAVER