Provider Demographics
NPI:1346247178
Name:VILLAGE AT COOK SPRINGS, LLC
Entity Type:Organization
Organization Name:VILLAGE AT COOK SPRINGS, LLC
Other - Org Name:VILLAGE AT COOK SPRINGS, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF REGULATORY AFFAIRS
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:E
Authorized Official - Last Name:ESTEP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-783-8472
Mailing Address - Street 1:600 CORPORATE PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-2934
Mailing Address - Country:US
Mailing Address - Phone:205-783-8472
Mailing Address - Fax:205-783-8441
Practice Address - Street 1:415 COOK SPRINGS RD
Practice Address - Street 2:
Practice Address - City:COOK SPRINGS
Practice Address - State:AL
Practice Address - Zip Code:35052-0010
Practice Address - Country:US
Practice Address - Phone:205-338-2221
Practice Address - Fax:205-814-3253
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NOLAND HEALTH SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-07
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10159310400000X
AL10943311500000X
AL10646314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL47530505Medicaid
AL01-5195Medicare ID - Type Unspecified
AL47530505Medicaid