Provider Demographics
NPI:1215235072
Name:HEALTHCARE AUTHORITY OF ELBA
Entity type:Organization
Organization Name:HEALTHCARE AUTHORITY OF ELBA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
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 1:980 DRAYTON AVE
Mailing Address - Street 2:
Mailing Address - City:ELBA
Mailing Address - State:AL
Mailing Address - Zip Code:36323-1404
Mailing Address - Country:US
Mailing Address - Phone:334-897-3800
Mailing Address - Fax:334-897-3804
Practice Address - Street 1:980 DRAYTON AVE
Practice Address - Street 2:
Practice Address - City:ELBA
Practice Address - State:AL
Practice Address - Zip Code:36323-1404
Practice Address - Country:US
Practice Address - Phone:334-897-3800
Practice Address - Fax:334-897-3804
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTHCARE AUTHORITY OF ELBA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-03
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALM030769261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
91689839813OtherINDIVIDUAL NPI
ALM030769OtherSTATE MEDICAL LICENSE NUMBER