Provider Demographics
NPI:1407205396
Name:ALICEVILLE MANOR NURSING HOME, INC.
Entity Type:Organization
Organization Name:ALICEVILLE MANOR NURSING HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:SIMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-353-5290
Mailing Address - Street 1:111 1ST AVE E
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:AL
Mailing Address - Zip Code:35121-1708
Mailing Address - Country:US
Mailing Address - Phone:205-625-5049
Mailing Address - Fax:205-625-5056
Practice Address - Street 1:703 17TH ST NW
Practice Address - Street 2:
Practice Address - City:ALICEVILLE
Practice Address - State:AL
Practice Address - Zip Code:35442-1426
Practice Address - Country:US
Practice Address - Phone:205-373-6307
Practice Address - Fax:205-373-2737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-10
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALN5402314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility