Provider Demographics
NPI:1366271967
Name:BAKE, JAMMIE (CEO)
Entity type:Individual
Prefix:
First Name:JAMMIE
Middle Name:
Last Name:BAKE
Suffix:
Gender:F
Credentials:CEO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6311 RIME VILLAGE DR NW APT 816
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35806-4457
Mailing Address - Country:US
Mailing Address - Phone:256-384-4482
Mailing Address - Fax:
Practice Address - Street 1:6311 RIME VILLAGE DR NW APT 816
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35806-4457
Practice Address - Country:US
Practice Address - Phone:256-384-4482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2420035374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide