Provider Demographics
NPI:1104017276
Name:LP BIRMINGHAM LLC
Entity Type:Organization
Organization Name:LP BIRMINGHAM LLC
Other - Org Name:HANOVER HEALTH & REHABILITATION CENTER AT BIRMINGHAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-568-7800
Mailing Address - Street 1:12201 BLUEGRASS PKWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-2361
Mailing Address - Country:US
Mailing Address - Phone:502-568-7800
Mailing Address - Fax:502-568-7150
Practice Address - Street 1:39 HANOVER CIR S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-1703
Practice Address - Country:US
Practice Address - Phone:205-933-1828
Practice Address - Fax:205-933-0900
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LP O HOLDINGS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-05
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
6102910001Medicare NSC
AL015423Medicare Oscar/Certification