Provider Demographics
NPI:1033292511
Name:CLEBURNE COUNTY HOSPITAL BOARD, INC.
Entity Type:Organization
Organization Name:CLEBURNE COUNTY HOSPITAL BOARD, INC.
Other - Org Name:CLEBURNE COUNTY NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:EURA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATORS LICEN
Authorized Official - Phone:256-463-2121
Mailing Address - Street 1:122 BROCKFORD RD
Mailing Address - Street 2:
Mailing Address - City:HEFLIN
Mailing Address - State:AL
Mailing Address - Zip Code:36264-7103
Mailing Address - Country:US
Mailing Address - Phone:256-463-2121
Mailing Address - Fax:256-463-7791
Practice Address - Street 1:122 BROCKFORD RD
Practice Address - Street 2:
Practice Address - City:HEFLIN
Practice Address - State:AL
Practice Address - Zip Code:36264-7103
Practice Address - Country:US
Practice Address - Phone:256-463-2121
Practice Address - Fax:256-463-7791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12503314000000X
ALN1501314000000X, 332BN1400X, 332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4750530SMedicaid
AL010547OtherBLUE CROSS BLUE SHIELD
AL01-5053Medicare ID - Type Unspecified
AL4750530SMedicaid