Provider Demographics
NPI:1881690154
Name:HALEYVILLE HEALTH CARE CENTER INC
Entity Type:Organization
Organization Name:HALEYVILLE HEALTH CARE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOOKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-486-9478
Mailing Address - Street 1:2201 11TH AVE
Mailing Address - Street 2:PO BOX 160
Mailing Address - City:HALEYVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35565-1613
Mailing Address - Country:US
Mailing Address - Phone:205-486-9478
Mailing Address - Fax:205-486-8393
Practice Address - Street 1:2201 11TH AVE
Practice Address - Street 2:
Practice Address - City:HALEYVILLE
Practice Address - State:AL
Practice Address - Zip Code:35565-1613
Practice Address - Country:US
Practice Address - Phone:205-486-9478
Practice Address - Fax:205-486-8393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-22
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10674314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4754830SMedicaid
AL010647OtherBCBS PROVIDER NUMBER
AL010647OtherBCBS PROVIDER NUMBER