Provider Demographics
NPI:1306894142
Name:COMMUNITY HOSPICE OF SOUTH ALABAMA, LLC
Entity type:Organization
Organization Name:COMMUNITY HOSPICE OF SOUTH ALABAMA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BUTTELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-723-7076
Mailing Address - Street 1:1450 NORTH MCKENZIE STREET
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535-2234
Mailing Address - Country:US
Mailing Address - Phone:251-943-5015
Mailing Address - Fax:251-943-3986
Practice Address - Street 1:1450 NORTH MCKENZIE STREET
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-2234
Practice Address - Country:US
Practice Address - Phone:251-943-5015
Practice Address - Fax:251-943-3986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALPIC1546EMedicaid
ALPIC1546EMedicaid