Provider Demographics
NPI:1255376430
Name:WASHINGTON COUNTY HEALTHCARE AUTHORITY, INC
Entity type:Organization
Organization Name:WASHINGTON COUNTY HEALTHCARE AUTHORITY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-847-2223
Mailing Address - Street 1:PO BOX 1299
Mailing Address - Street 2:
Mailing Address - City:CHATOM
Mailing Address - State:AL
Mailing Address - Zip Code:36518-1299
Mailing Address - Country:US
Mailing Address - Phone:251-847-2223
Mailing Address - Fax:251-847-3808
Practice Address - Street 1:14600 ST STEPHENS AVE
Practice Address - Street 2:
Practice Address - City:CHATOM
Practice Address - State:AL
Practice Address - Zip Code:36518
Practice Address - Country:US
Practice Address - Phone:251-847-2223
Practice Address - Fax:251-847-3808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12700314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4754420SMedicaid
AL4754420SMedicaid