Provider Demographics
NPI:1700816055
Name:JEFFERSON COUNTY DEPARTMENT OF HEALTH
Entity Type:Organization
Organization Name:JEFFERSON COUNTY DEPARTMENT OF HEALTH
Other - Org Name:PUBLIC HEALTH NURSING--HOME CARE DIVISION
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:GAYLE
Authorized Official - Last Name:WINSTON
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:205-930-1357
Mailing Address - Street 1:1400 6TH AVE S
Mailing Address - Street 2:POB 2648
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-1502
Mailing Address - Country:US
Mailing Address - Phone:205-930-1357
Mailing Address - Fax:205-930-1390
Practice Address - Street 1:1400 6TH AVE S
Practice Address - Street 2:POB 2648
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1502
Practice Address - Country:US
Practice Address - Phone:205-930-1357
Practice Address - Fax:205-930-1390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL073-H7008251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALJEF7008AMedicaid
AL51041619OtherBLUE CROSS BLUE SHIELD
ALJEF7008AMedicaid