Provider Demographics
NPI:1750469862
Name:PHENIX CITY HEALTH CARE, LLC
Entity type:Organization
Organization Name:PHENIX CITY HEALTH CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT/SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HUIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-625-3100
Mailing Address - Street 1:3900 LAKEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36867-2448
Mailing Address - Country:US
Mailing Address - Phone:334-298-8247
Mailing Address - Fax:334-298-1073
Practice Address - Street 1:3900 LAKEWOOD DR
Practice Address - Street 2:
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36867-2448
Practice Address - Country:US
Practice Address - Phone:334-298-8247
Practice Address - Fax:334-298-1073
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HUIE GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-02
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12670314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL47-533105Medicaid
AL47-533105Medicaid