1912301383 NPI number — ARBOR WOODS HEALTH AND REHAB LLC

Table of content: (NPI 1912301383)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912301383 NPI number — ARBOR WOODS HEALTH AND REHAB LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARBOR WOODS HEALTH AND REHAB 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:
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:
1912301383
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/02/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 400
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REFORM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35481-0400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-375-6379
Provider Business Mailing Address Fax Number:
205-375-8283

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
515 2ND AVE NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REFORM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35481-2331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-375-6379
Provider Business Practice Location Address Fax Number:
205-375-8283
Provider Enumeration Date:
10/14/2014

Additional Information

Authorized Official

Authorized Official Last Name:
TRAYLOR
Authorized Official First Name:
JONATHAN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
334-749-1471

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  N5401 , 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: 015141 . This is a "PTAN NUMBER" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 314000000X . This is a "TAXONOMY CODE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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