Basic Information
| Provider Information | |||||||||
| NPI: | 1841203171 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NHC HEALTHCARE-ANNISTON LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2300 COLEMAN RD | ||||||||
| Address2: | |||||||||
| City: | ANNISTON | ||||||||
| State: | AL | ||||||||
| PostalCode: | 362076824 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2300 COLEMAN RD | ||||||||
| Address2: | |||||||||
| City: | ANNISTON | ||||||||
| State: | AL | ||||||||
| PostalCode: | 362076824 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2568315730 | ||||||||
| FaxNumber: | 2568319107 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2006 | ||||||||
| LastUpdateDate: | 06/19/2008 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | CLEVELAND | ||||||||
| AuthorizedOfficialFirstName: | MIKE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PHRMCY DIR | ||||||||
| AuthorizedOfficialTelephone: | 2568315730 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | NATIONAL HEALTHCARE CORPORATION | ||||||||
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| AuthorizedOfficialCredential: | RPH | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336L0003X | 180056 | AL | Y | Suppliers | Pharmacy | Long Term Care Pharmacy |
ID Information
| ID | Type | State | Issuer | Description | 0117564 | 01 | OTHER ID NUMBER-COMMERCIAL NUMBER | OTHER | 100010079 | 05 | AL | MEDICAID |