Active NPI
Southeast Hospice Network, LLC
- Community Based Hospice Care Agency
- Hoover, AL
National Provider Identifier
1346307154
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Based Hospice Care Agency
- Legal business name
- SOUTHEAST HOSPICE NETWORK, LLC
- Practice address
- 2522 Valleydale Rd Ste 200
Hoover, AL 35244-2702 - Phone
- (205) 621-9970
- Fax
- (205) 621-9972
- NPI assigned
- Jan 2, 2007
- Organization subpart
- Yes
- Parent organization
- SOUTHEAST HOSPICE NETWORK, LLC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Debora Wilson, RN, BSN
- Title
- Executive Director
- Phone
- (205) 706-6809
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | Primary |
Addresses
Primary practice location
2522 Valleydale Rd Ste 200
Hoover, AL 35244-2702
Mailing address
1635 McFarland Blvd N Ste 503
Tuscaloosa, AL 35406-2204
Phone (205) 366-1605
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 105343 | Medicaid | AL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Part of
- Southeast Hospice Network LLC
Ownership & related parties
All disclosed owners & managing parties 3
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Scott Drummond | 5% Or Greater Direct Ownership Interest | Jan 16, 2007 | |
| Southeast Cancer Network, Inc. | 5% Or Greater Direct Ownership Interest | Jan 16, 2007 | |
| Debora Wilson | Corporate Director | Jan 16, 2007 | |
| W-2 Managing Employee | Jan 16, 2007 |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167696000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1558310400000",
"number": "1346307154",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1635 MCFARLAND BLVD N STE 503",
"city": "TUSCALOOSA",
"state": "AL",
"postal_code": "354062204",
"telephone_number": "205-366-1605",
"fax_number": "205-366-9698"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2522 VALLEYDALE RD STE 200",
"city": "HOOVER",
"state": "AL",
"postal_code": "352442702",
"telephone_number": "205-621-9970",
"fax_number": "205-621-9972"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SOUTHEAST HOSPICE NETWORK, LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "SOUTHEAST HOSPICE NETWORK, LLC",
"enumeration_date": "2007-01-02",
"last_updated": "2019-05-20",
"status": "A",
"authorized_official_last_name": "WILSON",
"authorized_official_first_name": "DEBORA",
"authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
"authorized_official_telephone_number": "205-706-6809",
"authorized_official_credential": "RN, BSN"
},
"taxonomies": [
{
"code": "251G00000X",
"taxonomy_group": "",
"desc": "Hospice Care, Community Based",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "105343",
"state": "AL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hoover, AL
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- Somnium Sleep Physicians
- Rodney Sones, DC
- South Haven Health and Rehabilitation, LLC
- South Trace Pediatrics, P.C.
- Southeastern Plastic Surgery Institute
- Southern Care Internal Medicine PC
- Southern Medical, Inc.
- Southern Orthopaedic Alliance, PLLC
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.