Provider Demographics
NPI:1861497935
Name:HOSPICE OF WEST ALABAMA, INC.
Entity type:Organization
Organization Name:HOSPICE OF WEST ALABAMA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LATRELLE
Authorized Official - Middle Name:PORTER
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:LBSW
Authorized Official - Phone:205-523-0101
Mailing Address - Street 1:3851 LOOP RD
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35404-5040
Mailing Address - Country:US
Mailing Address - Phone:205-523-0101
Mailing Address - Fax:205-523-0102
Practice Address - Street 1:3851 LOOP RD
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35404-5040
Practice Address - Country:US
Practice Address - Phone:205-523-0101
Practice Address - Fax:205-523-0102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10278251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALPIC1517EMedicaid
AL010497OtherBLUE CROSS/BLUE SHEILD
ALPIC1517EMedicaid