Provider Demographics
NPI:1891798930
Name:UCHEE PINES LIFESTYLE CENTER
Entity Type:Organization
Organization Name:UCHEE PINES LIFESTYLE CENTER
Other - Org Name:ANVWODI
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:IRWIN
Authorized Official - Last Name:HORSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-855-4764
Mailing Address - Street 1:30 UCHEE PINES ROAD
Mailing Address - Street 2:#75
Mailing Address - City:SEALE
Mailing Address - State:AL
Mailing Address - Zip Code:36875-5715
Mailing Address - Country:US
Mailing Address - Phone:334-855-4763
Mailing Address - Fax:334-855-9014
Practice Address - Street 1:30 UCHEE PINES RD
Practice Address - Street 2:LOT 75
Practice Address - City:SEALE
Practice Address - State:AL
Practice Address - Zip Code:36875-5726
Practice Address - Country:US
Practice Address - Phone:334-855-4763
Practice Address - Fax:334-855-9014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00019762174400000X
AL4123174400000X
GA025873174400000X
GA007539174400000X
GA04837174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A39052Medicare UPIN
ALE83701Medicare UPIN
AL06380Medicare ID - Type UnspecifiedAL PROVIDER #
C75651Medicare UPIN
AL36726Medicare ID - Type UnspecifiedAL PROVIDER #
GA07539Medicare ID - Type UnspecifiedGA PROVICER #
GA255BDBLBMedicare ID - Type UnspecifiedGA PROVICER #