Provider Demographics
NPI:1063465052
Name:GOODWATER HEALTHCARE CENTER LLC
Entity Type:Organization
Organization Name:GOODWATER HEALTHCARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOOK-KEEPER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:WEITHONER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-839-6711
Mailing Address - Street 1:16 JONES HILL RD
Mailing Address - Street 2:
Mailing Address - City:GOODWATER
Mailing Address - State:AL
Mailing Address - Zip Code:35072-9463
Mailing Address - Country:US
Mailing Address - Phone:256-839-6711
Mailing Address - Fax:256-839-6707
Practice Address - Street 1:16 JONES HILL RD
Practice Address - Street 2:
Practice Address - City:GOODWATER
Practice Address - State:AL
Practice Address - Zip Code:35072-9463
Practice Address - Country:US
Practice Address - Phone:256-839-6711
Practice Address - Fax:256-839-6707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12510314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4755800SMedicaid
AL015204Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER