Provider Demographics
NPI:1750480406
Name:CRENSHAW COUNTY HEALTH CARE AUTHORITY
Entity Type:Organization
Organization Name:CRENSHAW COUNTY HEALTH CARE AUTHORITY
Other - Org Name:CRENSHAW COMMUNITY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:KIMBRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-335-3374
Mailing Address - Street 1:PO BOX 5013
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36103-5013
Mailing Address - Country:US
Mailing Address - Phone:334-386-0343
Mailing Address - Fax:334-386-0382
Practice Address - Street 1:101 HOSPITAL CIR
Practice Address - Street 2:
Practice Address - City:LUVERNE
Practice Address - State:AL
Practice Address - Zip Code:36049-7329
Practice Address - Country:US
Practice Address - Phone:334-335-3374
Practice Address - Fax:334-335-1119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
275N00000X
AL11790282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL010083OtherHOSPITAL BC PROVIDER NUMB
ALHOS0008HMedicaid
AL559900100Medicaid
AL559900100Medicaid
ALJ021Medicare Oscar/Certification
AL01U008Medicare Oscar/Certification