Provider Demographics
NPI:1649389610
Name:THE HEALTH CARE AUTHORITY OF THE CITY OF ENTERPRISE, INC.
Entity Type:Organization
Organization Name:THE HEALTH CARE AUTHORITY OF THE CITY OF ENTERPRISE, INC.
Other - Org Name:ENTERPRISE HEALTH & REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:AVERETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-347-9541
Mailing Address - Street 1:300 PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36330-3311
Mailing Address - Country:US
Mailing Address - Phone:334-347-9541
Mailing Address - Fax:334-347-5070
Practice Address - Street 1:300 PLAZA DR
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-3311
Practice Address - Country:US
Practice Address - Phone:334-347-9541
Practice Address - Fax:334-347-5070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALN1602314000000X, 332B00000X, 332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0601900001OtherDME SUPPLIER
AL4753200SMedicaid
AL010605OtherBLUE CROSS/BLUE SHIELD
AL4753200SMedicaid
AL0601900001OtherDME SUPPLIER
AL015320Medicare Oscar/Certification