Provider Demographics
NPI:1134254832
Name:DIXIE NURSING CARE
Entity type:Organization
Organization Name:DIXIE NURSING CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:M
Authorized Official - Last Name:AMIS
Authorized Official - Suffix:JR
Authorized Official - Credentials:PVT DUTY NURSING AG
Authorized Official - Phone:662-563-1275
Mailing Address - Street 1:696 SILVER HILLS DR
Mailing Address - Street 2:SUITE 111
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36066-6184
Mailing Address - Country:US
Mailing Address - Phone:334-361-0195
Mailing Address - Fax:334-361-0633
Practice Address - Street 1:696 SILVER HILLS DR
Practice Address - Street 2:SUITE 111
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36066-6184
Practice Address - Country:US
Practice Address - Phone:334-361-0195
Practice Address - Fax:334-361-0633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL121402Medicaid
ALPVT0013ZMedicaid