Provider Demographics
NPI:1851607873
Name:COLBERT COUNTY-NORTHWEST ALABAMA HEALTHCARE AUTHORITY
Entity Type:Organization
Organization Name:COLBERT COUNTY-NORTHWEST ALABAMA HEALTHCARE AUTHORITY
Other - Org Name:RED BAY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NILES
Authorized Official - Middle Name:V
Authorized Official - Last Name:FLOYD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-356-9532
Mailing Address - Street 1:209 HOSPITAL ROAD
Mailing Address - Street 2:DBA/ RED BAY HOSPITAL BOX 490
Mailing Address - City:RED BAY
Mailing Address - State:AL
Mailing Address - Zip Code:35582
Mailing Address - Country:US
Mailing Address - Phone:256-356-9532
Mailing Address - Fax:256-356-2803
Practice Address - Street 1:209 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:RED BAY
Practice Address - State:AL
Practice Address - Zip Code:35582-3858
Practice Address - Country:US
Practice Address - Phone:256-356-9532
Practice Address - Fax:256-356-2809
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLBERT COUNTY-NORTHWEST ALABAMA HEALTHCARE AUTHORITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1073601043282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1073601043OtherPRIMARY TAXONOMY 282NC0060X 11805LICENSE NUMBER