Provider Demographics
NPI:1023050101
Name:RUSSELL COUNTY COMMUNITY HOSPITAL LLC
Entity type:Organization
Organization Name:RUSSELL COUNTY COMMUNITY HOSPITAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RACHAEL
Authorized Official - Middle Name:H
Authorized Official - Last Name:CRENSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-732-3010
Mailing Address - Street 1:4401 RIVER CHASE DRIVE
Mailing Address - Street 2:
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36867-7483
Mailing Address - Country:US
Mailing Address - Phone:334-732-3000
Mailing Address - Fax:334-732-3020
Practice Address - Street 1:4401 RIVER CHASE DR
Practice Address - Street 2:
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36867-7483
Practice Address - Country:US
Practice Address - Phone:334-732-3000
Practice Address - Fax:334-732-3020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
282N00000X
ALH5703282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALH050168HMedicaid
010168Medicare Oscar/Certification
ALH050168HMedicaid