Provider Demographics
NPI:1689750283
Name:RESURRECTION CATHOLIC MISSIONS OF THE SOUTH, INC
Entity Type:Organization
Organization Name:RESURRECTION CATHOLIC MISSIONS OF THE SOUTH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:H
Authorized Official - Last Name:HAYGOOD
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:334-230-1964
Mailing Address - Street 1:2815 FORBES DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36110-1307
Mailing Address - Country:US
Mailing Address - Phone:334-263-4221
Mailing Address - Fax:334-263-4999
Practice Address - Street 1:2815 FORBES DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36110-1307
Practice Address - Country:US
Practice Address - Phone:334-263-4221
Practice Address - Fax:334-263-4999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12471314000000X
AL126523140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Not Answered3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL47-52130SMedicaid
AL47-51050SMedicaid
AL015412Medicare ID - Type UnspecifiedRESURRECTION LIFE CENTER