Provider Demographics
NPI:1841343340
Name:SACRED HEART HEALTH SYSTEM, INC.
Entity type:Organization
Organization Name:SACRED HEART HEALTH SYSTEM, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:HETTERICH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:850-470-9288
Mailing Address - Street 1:6701 AIRPORT BLVD
Mailing Address - Street 2:SUITE 143
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-6705
Mailing Address - Country:US
Mailing Address - Phone:850-470-9288
Mailing Address - Fax:850-470-9130
Practice Address - Street 1:6701 AIRPORT BLVD
Practice Address - Street 2:SUITE 143
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-6705
Practice Address - Country:US
Practice Address - Phone:850-470-9288
Practice Address - Fax:850-470-9130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2006-004168332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL51503539OtherBCBS AL - DME
MS02078367Medicaid
FL8200162OtherUNITED HEALTH CARE
FL8200162OtherUNITED HEALTH CARE
FL=========OtherTRICARE
FL=========OtherHUMANA
MS02078367Medicaid
FL=========OtherHUMANA