Provider Demographics
NPI:1902904568
Name:HOSPICE OF NORTHWEST ALABAMA
Entity Type:Organization
Organization Name:HOSPICE OF NORTHWEST ALABAMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANNA
Authorized Official - Middle Name:HAMILTON
Authorized Official - Last Name:CANTRELL
Authorized Official - Suffix:
Authorized Official - Credentials:LBSW
Authorized Official - Phone:205-487-8140
Mailing Address - Street 1:PO BOX 1216
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:AL
Mailing Address - Zip Code:35594-1216
Mailing Address - Country:US
Mailing Address - Phone:205-487-8140
Mailing Address - Fax:205-487-8740
Practice Address - Street 1:1315 US HIGHWAY 43
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:AL
Practice Address - Zip Code:35594-5053
Practice Address - Country:US
Practice Address - Phone:205-487-8140
Practice Address - Fax:205-487-8740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11706251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALPIC1534EMedicaid
ALPIC1534EMedicaid