Provider Demographics
NPI:1891730438
Name:BALL HEALTHCARE-JEFFERSON, INC.
Entity Type:Organization
Organization Name:BALL HEALTHCARE-JEFFERSON, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-796-0214
Mailing Address - Street 1:1 SOUTHERN WAY
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36619-1210
Mailing Address - Country:US
Mailing Address - Phone:251-433-9801
Mailing Address - Fax:251-433-9807
Practice Address - Street 1:1250 JEFF GERMANY PKWY
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35214-4484
Practice Address - Country:US
Practice Address - Phone:205-796-0214
Practice Address - Fax:205-796-0169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12587314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4758100SMedicaid
AL015445Medicare Oscar/Certification
AL4758100SMedicaid