Provider Demographics
NPI:1972509453
Name:RESURRECTION LIFE CENTER
Entity Type:Organization
Organization Name:RESURRECTION LIFE CENTER
Other - Org Name:RESURRECTION CATHOLIC MISSIONS OF THE SOUTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:REV CR
Authorized Official - Phone:334-263-4221
Mailing Address - Street 1:1240 COUNTY ROAD 39
Mailing Address - Street 2:
Mailing Address - City:DEATSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36022-2536
Mailing Address - Country:US
Mailing Address - Phone:334-263-0618
Mailing Address - Fax:334-230-2056
Practice Address - Street 1:1240 COUNTY ROAD 39
Practice Address - Street 2:
Practice Address - City:DEATSVILLE
Practice Address - State:AL
Practice Address - Zip Code:36022-2536
Practice Address - Country:US
Practice Address - Phone:334-263-0618
Practice Address - Fax:334-230-2056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4752130SMedicaid
AL015412Medicare ID - Type Unspecified
AL4752130SMedicaid