1609868595 NPI number — ALTOONA HEALTH & REHAB, INC.

Table of content: (NPI 1609868595)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609868595 NPI number — ALTOONA HEALTH & REHAB, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALTOONA HEALTH & REHAB, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ALTOONA HEALTH & REHAB
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609868595
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 68
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALTOONA
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35952
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-589-6394
Provider Business Mailing Address Fax Number:
205-589-2112

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6532 WALNUT GROVE RD
Provider Second Line Business Practice Location Address:
6532 WALNUT GROVE RD
Provider Business Practice Location Address City Name:
ALTOONA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35952-8405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-589-6394
Provider Business Practice Location Address Fax Number:
205-589-2112
Provider Enumeration Date:
08/17/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BIGELOW
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
205-589-6394

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  10522 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4757390S . This is a "MEDICAID PROVIDER NUMBER" identifier , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010483 . This is a "BLUE CROSS BLUE SHEILD AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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