Provider Demographics
NPI:1306179429
Name:FAIRHOPE HEALTH & REHAB, LLC
Entity Type:Organization
Organization Name:FAIRHOPE HEALTH & REHAB, LLC
Other - Org Name:FAIRHOPE HEALTH & REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:WINGET
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:478-994-3669
Mailing Address - Street 1:108 S CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-2308
Mailing Address - Country:US
Mailing Address - Phone:251-928-2153
Mailing Address - Fax:251-928-4763
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:251-928-4763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-08
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALN0201314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL47-57350SMedicaid
AL015222Medicare Oscar/Certification