Provider Demographics
NPI:1962902551
Name:IMMANUEL HOME CARE, INC
Entity type:Organization
Organization Name:IMMANUEL HOME CARE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER-DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:GLERIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-929-8358
Mailing Address - Street 1:317 OLD HIGHWAY 431 STE C
Mailing Address - Street 2:
Mailing Address - City:OWENS CROSS ROADS
Mailing Address - State:AL
Mailing Address - Zip Code:35763-9265
Mailing Address - Country:US
Mailing Address - Phone:256-716-9940
Mailing Address - Fax:256-716-9181
Practice Address - Street 1:317 OLD HIGHWAY 431 STE C
Practice Address - Street 2:
Practice Address - City:OWENS CROSS ROADS
Practice Address - State:AL
Practice Address - Zip Code:35763-9265
Practice Address - Country:US
Practice Address - Phone:256-716-9940
Practice Address - Fax:256-716-9181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health