Basic Information
| Provider Information | |||||||||
| NPI: | 1538104484 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NHC HEALTHCARE-ANNISTON LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2300 COLEMAN RD | ||||||||
| Address2: | |||||||||
| City: | ANNISTON | ||||||||
| State: | AL | ||||||||
| PostalCode: | 362076824 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2568315730 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2300 COLEMAN RD | ||||||||
| Address2: | |||||||||
| City: | ANNISTON | ||||||||
| State: | AL | ||||||||
| PostalCode: | 362076824 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2568315730 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2006 | ||||||||
| LastUpdateDate: | 06/16/2008 | ||||||||
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| AuthorizedOfficialLastName: | JOHNSON | ||||||||
| AuthorizedOfficialFirstName: | DORAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9314241456 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | NATIONAL HEALTHCARE CORPORATION | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 12490 | AL | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 011200 | 01 | AL | BCBS | OTHER | 4754300S | 05 | AL | MEDICAID |