Provider Demographics
NPI:1861484404
Name:DEKALB BAPTIST MEDICAL CENTER HOME HEALTH
Entity type:Organization
Organization Name:DEKALB BAPTIST MEDICAL CENTER HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUNO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-524-2411
Mailing Address - Street 1:13280 COUNTY ROAD 51
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35961-4174
Mailing Address - Country:US
Mailing Address - Phone:256-524-2411
Mailing Address - Fax:256-524-2415
Practice Address - Street 1:13280 COUNTY ROAD 51
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35961-4174
Practice Address - Country:US
Practice Address - Phone:256-524-2411
Practice Address - Fax:256-524-2415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL01-7093Medicare ID - Type UnspecifiedMEDICARE #