Provider Demographics
NPI:1265794598
Name:HEALTH CARE FOR LIFE AL, LLC
Entity type:Organization
Organization Name:HEALTH CARE FOR LIFE AL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:M
Authorized Official - Last Name:GREENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:256-324-1918
Mailing Address - Street 1:PO BOX 335
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35653-0335
Mailing Address - Country:US
Mailing Address - Phone:205-208-9955
Mailing Address - Fax:256-332-5403
Practice Address - Street 1:523 GANDY ST NE
Practice Address - Street 2:STE A
Practice Address - City:RUSSELLVILLE
Practice Address - State:AL
Practice Address - Zip Code:35653-1961
Practice Address - Country:US
Practice Address - Phone:205-208-9955
Practice Address - Fax:256-332-5403
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTH CARE FOR LIFE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-06-12
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL142739Medicaid
AL102G700707Medicare PIN