Provider Demographics
NPI:1346244217
Name:HANCEVILLE NURSING & REHAB CENTER INC.
Entity Type:Organization
Organization Name:HANCEVILLE NURSING & REHAB CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:VICKERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-352-9100
Mailing Address - Street 1:420 MAIN ST., N.E.
Mailing Address - Street 2:
Mailing Address - City:HANCEVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35077
Mailing Address - Country:US
Mailing Address - Phone:256-352-9100
Mailing Address - Fax:256-352-3136
Practice Address - Street 1:420 MAIN ST., N.E.
Practice Address - Street 2:
Practice Address - City:HANCEVILLE
Practice Address - State:AL
Practice Address - Zip Code:35077
Practice Address - Country:US
Practice Address - Phone:256-352-9100
Practice Address - Fax:256-352-3136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-09
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL09989314000000X
ALN2203314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4750730SMedicaid
015073Medicare PIN
AL5566510001Medicare NSC