Provider Demographics
NPI:1235114901
Name:SELF HEALTH CARE AND REHAB CENTER INC
Entity Type:Organization
Organization Name:SELF HEALTH CARE AND REHAB CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:J
Authorized Official - Middle Name:A
Authorized Official - Last Name:SELF
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:205-491-2411
Mailing Address - Street 1:131 E CREST RD
Mailing Address - Street 2:
Mailing Address - City:HUEYTOWN
Mailing Address - State:AL
Mailing Address - Zip Code:35023-1623
Mailing Address - Country:US
Mailing Address - Phone:205-491-2411
Mailing Address - Fax:205-491-8750
Practice Address - Street 1:131 E CREST RD
Practice Address - Street 2:
Practice Address - City:HUEYTOWN
Practice Address - State:AL
Practice Address - Zip Code:35023-1623
Practice Address - Country:US
Practice Address - Phone:205-491-2411
Practice Address - Fax:205-491-8750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-14
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11106314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4753430SMedicaid
AL0584500001Medicare NSC
C73835Medicare UPIN
AL015212Medicare Oscar/Certification