Provider Demographics
NPI:1134648405
Name:NOLAND FAIRHOPE, LLC
Entity Type:Organization
Organization Name:NOLAND FAIRHOPE, LLC
Other - Org Name:FAIRHOPE HEALTH AND REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EVP/CFO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:GARY
Authorized Official - Last Name:GOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-783-8460
Mailing Address - Street 1:600 CORPORATE PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5451
Mailing Address - Country:US
Mailing Address - Phone:205-783-8444
Mailing Address - Fax:
Practice Address - Street 1:108 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-2308
Practice Address - Country:US
Practice Address - Phone:251-928-2153
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-18
Last Update Date:2017-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALN0201314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility