Provider Demographics
NPI:1861795890
Name:APPLETON SENIOR CARE, INC
Entity type:Organization
Organization Name:APPLETON SENIOR CARE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FRANCHISE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHAINE
Authorized Official - Middle Name:J
Authorized Official - Last Name:BUFFALOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-764-0387
Mailing Address - Street 1:PO BOX 2329
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35403-2329
Mailing Address - Country:US
Mailing Address - Phone:205-764-0387
Mailing Address - Fax:205-764-0569
Practice Address - Street 1:3630 NORTHBROOK DR
Practice Address - Street 2:SUITE B
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35473-5822
Practice Address - Country:US
Practice Address - Phone:205-764-0387
Practice Address - Fax:205-764-0569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-14
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALR007434438OtherVETERANS ADMIN