Provider Demographics
NPI:1659887883
Name:COLDWATER HEALTHCARE LLC
Entity Type:Organization
Organization Name:COLDWATER HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ACNP-BC
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:LAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:ACNP
Authorized Official - Phone:256-381-0085
Mailing Address - Street 1:130 KELLER PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:TUSCUMBIA
Mailing Address - State:AL
Mailing Address - Zip Code:35674-1416
Mailing Address - Country:US
Mailing Address - Phone:256-381-0085
Mailing Address - Fax:256-381-0907
Practice Address - Street 1:130 KELLER PARK BLVD
Practice Address - Street 2:
Practice Address - City:TUSCUMBIA
Practice Address - State:AL
Practice Address - Zip Code:35674-1416
Practice Address - Country:US
Practice Address - Phone:256-381-0085
Practice Address - Fax:256-381-0907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-26
Last Update Date:2017-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service