Basic Information
| Provider Information | |||||||||
| NPI: | 1457566390 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHANDLER HEALTH & REHAB CENTER, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CHANDLER HEALTH & REHAB CENTER, LLC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 850 9TH STREET NW | ||||||||
| Address2: | |||||||||
| City: | ALABASTER | ||||||||
| State: | AL | ||||||||
| PostalCode: | 350079179 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2056633859 | ||||||||
| FaxNumber: | 2056639791 | ||||||||
| Practice Location | |||||||||
| Address1: | 850 9TH STREET NW | ||||||||
| Address2: | |||||||||
| City: | ALABASTER | ||||||||
| State: | AL | ||||||||
| PostalCode: | 350079179 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2056639791 | ||||||||
| FaxNumber: | 2056633859 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2007 | ||||||||
| LastUpdateDate: | 03/02/2015 | ||||||||
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| AuthorizedOfficialLastName: | WINGET | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4789943669 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | SR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 12790 | AL | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 4754170S | 05 | AL | MEDICAID |