Provider Demographics
NPI:1093802639
Name:MANOR CARE HEALTH SERVICES INC.
Entity Type:Organization
Organization Name:MANOR CARE HEALTH SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:RANDAL
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-332-1810
Mailing Address - Street 1:390 UNDERWOOD RD
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35653-4105
Mailing Address - Country:US
Mailing Address - Phone:256-332-1810
Mailing Address - Fax:256-332-3874
Practice Address - Street 1:390 UNDERWOOD RD
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AL
Practice Address - Zip Code:35653-4105
Practice Address - Country:US
Practice Address - Phone:256-332-1810
Practice Address - Fax:256-332-3874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALEXEMPT332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0667040001OtherDME MAC
0667040001Medicare NSC