Provider Demographics
NPI:1962171272
Name:HH HEALTH SYSTEM - JACKSON LLC
Entity type:Organization
Organization Name:HH HEALTH SYSTEM - JACKSON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:E
Authorized Official - Last Name:CHATMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-218-3680
Mailing Address - Street 1:PO BOX 1002
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35740-1002
Mailing Address - Country:US
Mailing Address - Phone:256-437-7260
Mailing Address - Fax:256-437-7190
Practice Address - Street 1:47065 AL HIGHWAY 277
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:AL
Practice Address - Zip Code:35740-7205
Practice Address - Country:US
Practice Address - Phone:256-437-7260
Practice Address - Fax:256-437-7190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4757920SMedicaid