Basic Information
| Provider Information | |||||||||
| NPI: | 1457326415 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HEALTHGROUP OF ALABAMA, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HOME HEALTH GROUP - DECATUR | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6767 OLD MADISON PIKE | ||||||||
| Address2: | STE 400 | ||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 35806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2569226650 | ||||||||
| FaxNumber: | 2569226651 | ||||||||
| Practice Location | |||||||||
| Address1: | 1323 STRATFORD RD | ||||||||
| Address2: | SUITE B | ||||||||
| City: | DECATUR | ||||||||
| State: | AL | ||||||||
| PostalCode: | 35601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2563504182 | ||||||||
| FaxNumber: | 2563095908 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2006 | ||||||||
| LastUpdateDate: | 10/24/2007 | ||||||||
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| AuthorizedOfficialLastName: | DOTSON | ||||||||
| AuthorizedOfficialFirstName: | PHILIP | ||||||||
| AuthorizedOfficialMiddleName: | E. | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2569226680 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 04924314 | 05 | MS | MEDICAID | 5753137 | 01 | AETNA | OTHER | 51516749 | 01 | AL | BLUE CROSS BLUE SHIELD | OTHER | HEL7027A | 05 | AL | MEDICAID |