NPIMap

Organization Active NPI

Hospice of West Alabama, Inc.

  • Community Based Hospice Care Agency
  • Tuscaloosa, AL
National Provider Identifier
1861497935
Registry record updated Jul 12, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
10278 Issued in AL
Legal business name
HOSPICE OF WEST ALABAMA, INC.
Practice address
3851 Loop Rd
Tuscaloosa, AL 35404-5040
Phone
(205) 523-0101
Fax
(205) 523-0102
NPI assigned
Jun 16, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2012

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

Authorized official

Name
Mrs. Latrelle Porter Bell, LBSW
Title
Executive Director
Phone
(205) 523-0101

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X 10278 AL Primary

Addresses

Primary practice location

3851 Loop Rd
Tuscaloosa, AL 35404-5040

Mailing address

3851 Loop Rd
Tuscaloosa, AL 35404-5040
Phone (205) 523-0101

Other identifiers 2

IdentifierTypeStateIssuer
PIC1517EMedicaidAL
010497OtherALBLUE CROSS/BLUE SHEILD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040723000977 AL Part A Provider - Hospice 6204816754 Practice locations: Tuscaloosa, AL

Hospice certification: CCN 011517

Legal name
HOSPICE OF WEST ALABAMA, INC
Certification status
Active
Provider type (POS)
Hospice
Participating since
Feb 8, 1989
Last certification
Nov 10, 2010
Ownership / control type
Non-Profit - Private
Organization structure
CorporationProprietary
Incorporated
Apr 23, 1980 in AL
Enrollment address
3851 Loop Rd
Tuscaloosa, AL 35404-5040

Care Compare: Hospice

Medicare Care Compare
Listed as
Hospice of West AlabamaCCN 011517
Ownership
Non-Profit
Certified
Feb 8, 1989
Medicare certification status
ActiveFrom the Provider of Services file

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
01D0886813Hospice of West Alabama3851 Loop Rd, Tuscaloosa, AL 35404Certificate of waiverMay 26, 2028

National Provider Directory

National Provider Directory

Locations

3851 Loop Rd
Tuscaloosa, AL 35404
Phone (205) 523-0101

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Barbara Weatherly Individual Operational/Managerial ControlDirector of Business Services Aug 17, 2007
Deborah Tucker Individual Corporate Director Jul 23, 2004
Latrelle Bell Individual 5% Or Greater Direct Ownership InterestExecutive Director Aug 17, 2007
Corporate DirectorExecutive Director Aug 17, 2007
Matthew Tompkins Individual Corporate Director Mar 1, 2012
Terry Waters Individual Corporate Director Jul 23, 2004
Thomas Corder Individual Corporate Director Mar 1, 2012
James Brazil, J. Individual Corporate Director Mar 1, 2012
Melanie Robertson Individual Operational/Managerial ControlCoo Aug 17, 2007
George Miller Individual Corporate Director Jul 23, 2004
Paula Quarles Individual Corporate Director Jul 23, 2004

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 14

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1118880000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1342051200000",
    "number": "1861497935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3851 LOOP RD",
            "city": "TUSCALOOSA",
            "state": "AL",
            "postal_code": "354045040",
            "telephone_number": "205-523-0101",
            "fax_number": "205-523-0102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3851 LOOP RD",
            "city": "TUSCALOOSA",
            "state": "AL",
            "postal_code": "354045040",
            "telephone_number": "205-523-0101",
            "fax_number": "205-523-0102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOSPICE OF WEST ALABAMA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-16",
        "last_updated": "2012-07-12",
        "status": "A",
        "authorized_official_last_name": "BELL",
        "authorized_official_first_name": "LATRELLE",
        "authorized_official_middle_name": "PORTER",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "205-523-0101",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LBSW"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "AL",
            "license": "10278",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PIC1517E",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHEILD",
            "identifier": "010497",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tuscaloosa, AL

Sources for this page

Verify at the official NPI Registry.