Provider Demographics
NPI:1982713087
Name:METHODIST HOME FOR THE AGING
Entity Type:Organization
Organization Name:METHODIST HOME FOR THE AGING
Other - Org Name:WESLEY PLACE ON HONEYSUCKLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:T
Authorized Official - Last Name:LAWLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-951-2442
Mailing Address - Street 1:1520 COOPER HILL RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35210-2303
Mailing Address - Country:US
Mailing Address - Phone:205-951-2442
Mailing Address - Fax:205-956-5001
Practice Address - Street 1:718 HONEYSUCKLE RD
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-1104
Practice Address - Country:US
Practice Address - Phone:334-792-0921
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:METHODIST HOME FOR THE AGING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-30
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12551314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4753670SMedicaid
AL015175Medicare Oscar/Certification