NPIMap

Organization Active NPI

The Health Care Authority of the City of Greenville - LV Stabler Hospi

  • Psychiatric Hospital Unit
  • Greenville, AL
National Provider Identifier
1811968308
Registry record updated Feb 26, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Hospital UnitTaxonomy code 273R00000X
License
10318 Issued in AL
Legal business name
THE HEALTH CARE AUTHORITY OF THE CITY OF GREENVILLE - LV STABLER HOSPI
Practice address
29 L V Stabler Dr
Greenville, AL 36037-3850
Phone
(334) 382-2671
NPI assigned
Feb 1, 2006
Last updated
Feb 26, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
THE HEALTH CARE AUTHORITY OF THE CITY OF GREENVILLE - LV STABLER HOSPIAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 26, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
David Glenn Wilcox, CPA
Title
Cfo
Phone
(334) 383-2423

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital Unit 273R00000X 10318 AL Primary

Addresses

Primary practice location

29 L V Stabler Dr
Greenville, AL 36037-3850

Mailing address

29 L V Stabler Dr
Greenville, AL 36037-3850
Phone (334) 383-2423

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180828001823 AL Part A Provider - Hospital 9436418209 Practice locations: Greenville, AL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1811968308. Details of each certification follow.

Hospital certification: CCN 01S150

Legal name
THE HEALTH CARE AUTHORITY OF THE CITY OF GREENVILLE - LV STABLER HOSPI
Doing business as
REGIONAL MEDICAL CENTER OF CENTRAL ALABAMA
Organization structure
GovernmentNon-profit
Incorporated
Nov 1, 2017 in AL
Enrollment address
29 L V Stabler Dr
Greenville, AL 36037-3850
Hospital Psychiatric Unit
Hospital subgroups
Psychiatric unit

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Ivy Creek of Butler LLC7 organizations share this tax ID, including this one
Part of
Ivy Creek of Butler LLC

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 8

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Phillip Fouts Individual Corporate DirectorChief Financial Officer May 1, 2023 50%
W-2 Managing EmployeeChief Financial Officer May 1, 2023 50%
Dexter McLendon Individual Corporate DirectorBoard Member Jul 18, 2017
James Dunklin Individual Corporate DirectorBoard Member Jul 18, 2017
John Selman Individual Corporate DirectorBoard Member Nov 1, 2017
The Health Care Authority of the City of Greenville - LV Stabler Hospi Organization, Greenville, AL Created for acquisition 5% Or Greater Direct Ownership Interest Nov 1, 2017 100%
Eddie Cook Individual Corporate DirectorBoard Member Jul 18, 2017
Donald Lilly Individual Corporate DirectorBoard Member Nov 1, 2017
Michael Patrick Trammell Individual Corporate DirectorCeo Jan 1, 2023 50%
W-2 Managing EmployeeCeo Jan 1, 2023 50%

Owners & managing parties with NPI records 4

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Regional Medical Center of Central AlabamaGreenville, AL, CCN 010150 Hospital 5% Or Greater Direct Ownership Interest (100%) Nov 1, 2017
Regional Medical Center of Central AlabamaGreenville, AL, CCN 01U150 Hospital 5% Or Greater Direct Ownership Interest (100%) Nov 1, 2017
Regional Medical Center ClinicsGreenville, AL, CCN 013457 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2019

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 3

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1138752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1519603200000",
    "number": "1811968308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29 L V STABLER DR",
            "city": "GREENVILLE",
            "state": "AL",
            "postal_code": "360373850",
            "telephone_number": "334-383-2423",
            "fax_number": "334-382-0305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29 L V STABLER DR",
            "city": "GREENVILLE",
            "state": "AL",
            "postal_code": "360373850",
            "telephone_number": "334-382-2671"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE HEALTH CARE AUTHORITY OF THE CITY OF GREENVILLE - LV STABLER HOSPI",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THE HEALTH CARE AUTHORITY OF THE CITY OF GREENVILLE - LV STABLER HOSPI",
        "enumeration_date": "2006-02-01",
        "last_updated": "2018-02-26",
        "status": "A",
        "authorized_official_last_name": "WILCOX",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "GLENN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "334-383-2423",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": "AL",
            "license": "10318",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, AL

Sources for this page

Verify at the official NPI Registry.