Provider Demographics
NPI:1992122709
Name:STAFF MEDICAL SERVICE HOME HEALTH,INC
Entity type:Organization
Organization Name:STAFF MEDICAL SERVICE HOME HEALTH,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:RUBY
Authorized Official - Middle Name:
Authorized Official - Last Name:STOCKDALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-405-4022
Mailing Address - Street 1:1200 NOBLE ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36201-4659
Mailing Address - Country:US
Mailing Address - Phone:256-405-4022
Mailing Address - Fax:256-365-2060
Practice Address - Street 1:1200 NOBLE ST
Practice Address - Street 2:SUITE 101
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36201-4659
Practice Address - Country:US
Practice Address - Phone:256-405-4022
Practice Address - Fax:256-365-2060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-19
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL133832252Y00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No252Y00000XAgenciesEarly Intervention Provider Agency