1407205396 NPI number — ALICEVILLE MANOR NURSING HOME, INC.

Table of content: CHRISTINE MICHELLE LANHAM LPC (NPI 1811956428)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407205396 NPI number — ALICEVILLE MANOR NURSING HOME, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALICEVILLE MANOR NURSING HOME, 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:
Provider Other Organization Name Type Code:
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:
1407205396
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/10/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 1ST AVE E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ONEONTA
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35121-1708
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-625-5049
Provider Business Mailing Address Fax Number:
205-625-5056

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
703 17TH ST NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALICEVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35442-1426
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-373-6307
Provider Business Practice Location Address Fax Number:
205-373-2737
Provider Enumeration Date:
06/10/2016

Additional Information

Authorized Official

Authorized Official Last Name:
SIMS
Authorized Official First Name:
MARK
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
205-353-5290

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  N5402 , 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)





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