Organization
PRIVATE DUTY NURSING SERVICE, INX
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. NITA F. WALLACE (PRESIDENT/CEO)
(256) 355-1811
Entity
Organization
Contact information
Practice address
1530 WOLVERINE DR SE, DECATUR, AL 35601-4949
(256) 355-1811
(256) 355-8419
Mailing address
1530 WOLVERINE DR SE, DECATUR, AL 35601-4949
(256) 355-1811
(256) 355-8419
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
04825
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
510-34325
BLUE CROSS BLUE SHIELD
AL
05
—
PVT0063Z
—
AL
05
—
PVT0069Z
—
AL
Enumeration date
07/19/2006
Last updated
08/22/2020
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