Provider Demographics
NPI:1003806092
Name:JEFFERSON COUNTY COMMISSION
Entity Type:Organization
Organization Name:JEFFERSON COUNTY COMMISSION
Other - Org Name:JEFFERSON REHAB. & HEALTH CTR.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:205-849-2352
Mailing Address - Street 1:200 N PINE HILL RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35217-1215
Mailing Address - Country:US
Mailing Address - Phone:205-849-2352
Mailing Address - Fax:205-849-2371
Practice Address - Street 1:200 N PINE HILL RD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35217-1215
Practice Address - Country:US
Practice Address - Phone:205-849-2352
Practice Address - Fax:205-849-2371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-21
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11181314000000X
332BN1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL63 6002579OtherHM BENEFITS ADMINISTRATORS, INC. (USA CORP.)
AL71-10036OtherUNITED HEALTHCARE
AL4753490SMedicaid
AL010-517OtherBLUE CROSS BLUE SHIELD
AL71-10036OtherUNITED HEALTHCARE
AL0477760001Medicare NSC
AL71-10036OtherUNITED HEALTHCARE