Provider Demographics
NPI:1760595896
Name:LIFECARE OF ALABAMA, INC.
Entity Type:Organization
Organization Name:LIFECARE OF ALABAMA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLINGMAN BANKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-773-6035
Mailing Address - Street 1:PO BOX 1105
Mailing Address - Street 2:
Mailing Address - City:HARTSELLE
Mailing Address - State:AL
Mailing Address - Zip Code:35640-1105
Mailing Address - Country:US
Mailing Address - Phone:256-773-6035
Mailing Address - Fax:256-751-4855
Practice Address - Street 1:532 SPARKMAN ST SW
Practice Address - Street 2:
Practice Address - City:HARTSELLE
Practice Address - State:AL
Practice Address - Zip Code:35640-3120
Practice Address - Country:US
Practice Address - Phone:256-773-6035
Practice Address - Fax:256-751-4805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL8063416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-51761OtherBLUE CROSS BLUE SHIELD
AL510-91197OtherBLUE CROSS BLUE SHIELD
AL=========OtherRAILROAD MEDICARE
AL=========OtherUMWA
AL510-91197OtherBLUE CROSS BLUE SHIELD