Provider Demographics
NPI:1053381905
Name:THE HEALTH CARE AUTHORITY OF THE CITY OF GREENVILLE - LV STABLER HOSPI
Entity type:Organization
Organization Name:THE HEALTH CARE AUTHORITY OF THE CITY OF GREENVILLE - LV STABLER HOSPI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:GLENN
Authorized Official - Last Name:WILCOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-383-2423
Mailing Address - Street 1:104 CAMELLIA AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:GREENVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36037-1514
Mailing Address - Country:US
Mailing Address - Phone:334-383-2286
Mailing Address - Fax:334-383-2343
Practice Address - Street 1:104 CAMELLIA AVE
Practice Address - Street 2:SUITE B
Practice Address - City:GREENVILLE
Practice Address - State:AL
Practice Address - Zip Code:36037-1514
Practice Address - Country:US
Practice Address - Phone:334-383-2286
Practice Address - Fax:334-383-2343
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE HEALTH CARE AUTHORITY OF THE CITY OF GREENVILLE - LV STABLER HOSPI
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-01-24
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALLVS7138AMedicaid
ALLVS7138AMedicaid