Provider Demographics
NPI:1275221129
Name:ARABELLA HEALTH & WELLNESS OF MONTGOMERY OPCO LLC
Entity Type:Organization
Organization Name:ARABELLA HEALTH & WELLNESS OF MONTGOMERY OPCO LLC
Other - Org Name:ARABELLA HEALTH & WELLNESS OF MONTGOMERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED SIGNATORY
Authorized Official - Prefix:
Authorized Official - First Name:CHAIM
Authorized Official - Middle Name:N
Authorized Official - Last Name:HERTZEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-930-6124
Mailing Address - Street 1:4490 VIRGINIA LOOP RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116-3448
Mailing Address - Country:US
Mailing Address - Phone:334-281-6826
Mailing Address - Fax:334-281-6901
Practice Address - Street 1:4490 VIRGINIA LOOP RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-3448
Practice Address - Country:US
Practice Address - Phone:334-281-6826
Practice Address - Fax:334-281-6901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility