Provider Demographics
NPI:1316997430
Name:GROVE HILL MEMORIAL HOSPITAL, INC
Entity type:Organization
Organization Name:GROVE HILL MEMORIAL HOSPITAL, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:WILSON
Authorized Official - Last Name:LARRIMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-275-3173
Mailing Address - Street 1:PO BOX 935
Mailing Address - Street 2:
Mailing Address - City:GROVE HILL
Mailing Address - State:AL
Mailing Address - Zip Code:36451-0935
Mailing Address - Country:US
Mailing Address - Phone:251-275-3191
Mailing Address - Fax:251-275-4281
Practice Address - Street 1:297 S JACKSON ST
Practice Address - Street 2:
Practice Address - City:GROVE HILL
Practice Address - State:AL
Practice Address - Zip Code:36451-3231
Practice Address - Country:US
Practice Address - Phone:251-275-2286
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL01-3429Medicare ID - Type Unspecified