Provider Demographics
NPI:1972603991
Name:DALE MEDICAL CENTER
Entity Type:Organization
Organization Name:DALE MEDICAL CENTER
Other - Org Name:COMMUNITY HOSPICE OF DALE MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:VERNON
Authorized Official - Middle Name:L
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:BS MSHA
Authorized Official - Phone:334-774-2601
Mailing Address - Street 1:126 HOSPITAL AVE
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:AL
Mailing Address - Zip Code:36360-2018
Mailing Address - Country:US
Mailing Address - Phone:334-774-2601
Mailing Address - Fax:334-774-1766
Practice Address - Street 1:368 JAMES ST
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:AL
Practice Address - Zip Code:36360-2015
Practice Address - Country:US
Practice Address - Phone:334-774-2601
Practice Address - Fax:334-774-7600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11645251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL012-540OtherBCBS
ALPIC1628EMedicaid
AL012-540OtherBCBS