Provider Demographics
NPI:1053571588
Name:HEALTHCARE AUTHORITY OF ELBA INC
Entity type:Organization
Organization Name:HEALTHCARE AUTHORITY OF ELBA INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:BRILEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:334-897-2257
Mailing Address - Street 1:987 DRAYTON AVE
Mailing Address - Street 2:
Mailing Address - City:ELBA
Mailing Address - State:AL
Mailing Address - Zip Code:36323-1402
Mailing Address - Country:US
Mailing Address - Phone:334-897-2257
Mailing Address - Fax:
Practice Address - Street 1:987 DRAYTON AVE
Practice Address - Street 2:
Practice Address - City:ELBA
Practice Address - State:AL
Practice Address - Zip Code:36323-1402
Practice Address - Country:US
Practice Address - Phone:334-897-2257
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTHCARE AUTHORITY OF ELBA INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL558300170Medicaid