Basic Information
| Provider Information | |||||||||
| NPI: | 1245343722 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | AMERICAN HEALTH CORPORATION AND SUBSIDIARIES | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | COLONIAL HAVEN HEALTH AND REHABILITATION | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 438 | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | AL | ||||||||
| PostalCode: | 367440438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3346243054 | ||||||||
| FaxNumber: | 3346241083 | ||||||||
| Practice Location | |||||||||
| Address1: | 616 ARMORY ST | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | AL | ||||||||
| PostalCode: | 367442110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3346243054 | ||||||||
| FaxNumber: | 3346241083 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2006 | ||||||||
| LastUpdateDate: | 03/24/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | CARTER | ||||||||
| AuthorizedOfficialFirstName: | TAMMY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CORPORATE BUSINESS OFFICE MANAG | ||||||||
| AuthorizedOfficialTelephone: | 2054289383 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 03/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 12547 | AL | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 4752120S | 05 | AL | MEDICAID |