1679531438 NPI number — ALLIANCE-LAIRD NURSING HOME, LLC

Table of content: (NPI 1679531438)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679531438 NPI number — ALLIANCE-LAIRD NURSING HOME, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLIANCE-LAIRD NURSING HOME, LLC
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:
J.G. ALEXANDER NURSING CENTER
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:
1679531438
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2106
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MERIDIAN
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39302-2106
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-703-4331
Provider Business Mailing Address Fax Number:
601-703-3080

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25112 HWY 15
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UNION
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39365
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-774-5065
Provider Business Practice Location Address Fax Number:
601-774-3353
Provider Enumeration Date:
05/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
STRICKLAND
Authorized Official First Name:
WALLACE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
205-459-4778

Provider Taxonomy Codes

  • Taxonomy code: 313M00000X , with the licence number:  999 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 314000000X , with the licence number: 999 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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





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