Provider Demographics
NPI:1396856829
Name:PERRY CTY HOSPITAL ASSN
Entity Type:Organization
Organization Name:PERRY CTY HOSPITAL ASSN
Other - Org Name:PERRY COUNTY NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBEKAH
Authorized Official - Middle Name:G
Authorized Official - Last Name:BONDS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN, LNHA
Authorized Official - Phone:334-683-9696
Mailing Address - Street 1:P.O. BOX 149
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:AL
Mailing Address - Zip Code:36756-0149
Mailing Address - Country:US
Mailing Address - Phone:334-683-9696
Mailing Address - Fax:334-683-9995
Practice Address - Street 1:505 E LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:AL
Practice Address - Zip Code:36756-2323
Practice Address - Country:US
Practice Address - Phone:334-683-9696
Practice Address - Fax:334-683-9995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2010-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12661314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4753140SMedicaid
AL009923325OtherMEDICAID DME
AL0416900001OtherPGBA
AL010555OtherBLUE CROSS
AL009923325OtherMEDICAID DME