Provider Demographics
NPI:1043217375
Name:WHEAT NURSING HOME INC
Entity Type:Organization
Organization Name:WHEAT NURSING HOME INC
Other - Org Name:ALICEVILLE MANOR NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:EVAN
Authorized Official - Last Name:WHEAT
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:205-373-6307
Mailing Address - Street 1:703 17TH ST NW
Mailing Address - Street 2:
Mailing Address - City:ALICEVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35442-1426
Mailing Address - Country:US
Mailing Address - Phone:205-373-6307
Mailing Address - Fax:205-373-2737
Practice Address - Street 1:703 17TH ST NW
Practice Address - Street 2:
Practice Address - City:ALICEVILLE
Practice Address - State:AL
Practice Address - Zip Code:35442-1426
Practice Address - Country:US
Practice Address - Phone:205-373-6307
Practice Address - Fax:205-373-2737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-01
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4754610S314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4754610SMedicaid
AL015137Medicare Oscar/Certification
AL4754610SMedicaid