Provider Demographics
NPI:1669868923
Name:PRIME HEALTHCARE SERVICES - GADSDEN LLC
Entity type:Organization
Organization Name:PRIME HEALTHCARE SERVICES - GADSDEN LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HEATHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-235-4400
Mailing Address - Street 1:600 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-5304
Mailing Address - Country:US
Mailing Address - Phone:256-543-5200
Mailing Address - Fax:256-543-5888
Practice Address - Street 1:600 S 3RD ST
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-5304
Practice Address - Country:US
Practice Address - Phone:256-543-5200
Practice Address - Fax:256-543-5888
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRIME HEALTHCARE SERVICES - GADSDEN LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-04-13
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALH2803273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALHOS0046HMedicaid
AL010046Medicare Oscar/Certification