Provider Demographics
NPI:1164496691
Name:BURNS NURSING HOME, INC.
Entity Type:Organization
Organization Name:BURNS NURSING HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:DEARMAN
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:256-332-4110
Mailing Address - Street 1:701 MONROE ST NW
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35653-1358
Mailing Address - Country:US
Mailing Address - Phone:256-332-4110
Mailing Address - Fax:256-332-4163
Practice Address - Street 1:701 MONROE ST NW
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AL
Practice Address - Zip Code:35653-1358
Practice Address - Country:US
Practice Address - Phone:256-332-4110
Practice Address - Fax:256-332-4163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-13
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL47-50090SMedicaid
AL015009Medicare Oscar/Certification
AL47-50090SMedicaid