Basic Information
Provider Information
NPI: 1508939745
EntityType: 2
ReplacementNPI:  
OrganizationName: BIRMINGHAM NURSING AND REHABILITATION CENTER, LLC
LastName:  
FirstName:  
MiddleName:  
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Credential:  
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Mailing Information
Address1: PO BOX 428
Address2:  
City: ORCHARD PARK
State: NY
PostalCode: 141270428
CountryCode: US
TelephoneNumber: 7166624955
FaxNumber: 7166679230
Practice Location
Address1: 1000 DUGAN AVE
Address2:  
City: BIRMINGHAM
State: AL
PostalCode: 352144326
CountryCode: US
TelephoneNumber: 2057988780
FaxNumber: 2057987685
Other Information
ProviderEnumerationDate: 11/16/2006
LastUpdateDate: 08/22/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: BENNETT
AuthorizedOfficialFirstName: NORBERT
AuthorizedOfficialMiddleName: A
AuthorizedOfficialTitleorPosition: CO-CHIEF EXECUTIVE OFFICER
AuthorizedOfficialTelephone: 7166624955
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
314000000XN3740ALY Nursing & Custodial Care FacilitiesSkilled Nursing Facility 

ID Information
IDTypeStateIssuerDescription
0038901ALBC BS OF ALABAMAOTHER
71-0001701ALMEDICARE COMPLETEOTHER
4757290S05AL MEDICAID


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