Provider Demographics
NPI:1619166634
Name:CENTRAL ALABAMA COMPREHENSIVE HEALTH, INC
Entity Type:Organization
Organization Name:CENTRAL ALABAMA COMPREHENSIVE HEALTH, INC
Other - Org Name:HURTSBORO FAMILY HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FINANCIAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:G
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-212-5602
Mailing Address - Street 1:203 WEST LEE STREET
Mailing Address - Street 2:
Mailing Address - City:TUSKEGEE
Mailing Address - State:AL
Mailing Address - Zip Code:36083-1719
Mailing Address - Country:US
Mailing Address - Phone:205-212-5602
Mailing Address - Fax:205-212-5610
Practice Address - Street 1:242 LONG STREET
Practice Address - Street 2:
Practice Address - City:HURTSBORO
Practice Address - State:AL
Practice Address - Zip Code:36860-0417
Practice Address - Country:US
Practice Address - Phone:334-667-7734
Practice Address - Fax:334-667-7733
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL ALABAMA COMPREHENSIVE HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-16
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL630002010Medicaid
AL011865Medicare PIN
O11865Medicare UPIN