Provider Demographics
NPI:1962913350
Name:BALDWIN COUNTY TRANSITIONAL CARE LLC
Entity type:Organization
Organization Name:BALDWIN COUNTY TRANSITIONAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SABRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:REEVES
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:251-300-0025
Mailing Address - Street 1:PO BOX 587
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36533-0587
Mailing Address - Country:US
Mailing Address - Phone:251-300-0025
Mailing Address - Fax:
Practice Address - Street 1:77 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-2540
Practice Address - Country:US
Practice Address - Phone:251-300-0025
Practice Address - Fax:855-292-8226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-12
Last Update Date:2019-09-12
Deactivation Date:2018-08-23
Deactivation Code:
Reactivation Date:2018-09-11
Provider Licenses
StateLicense IDTaxonomies
261QM2500X
ALPA1092363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51205740OtherBCBS-AL