Provider Demographics
NPI:1417003245
Name:CLAY COUNTY HEALTHCARE AUTHORITY
Entity Type:Organization
Organization Name:CLAY COUNTY HEALTHCARE AUTHORITY
Other - Org Name:CLAY COUNTY NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-354-2131
Mailing Address - Street 1:PO BOX 1270
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:AL
Mailing Address - Zip Code:36251-1270
Mailing Address - Country:US
Mailing Address - Phone:256-354-1141
Mailing Address - Fax:256-354-1244
Practice Address - Street 1:83825 HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:AL
Practice Address - Zip Code:36251-1270
Practice Address - Country:US
Practice Address - Phone:256-354-1141
Practice Address - Fax:256-354-1244
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLAY COUNTY HEALTHCARE AUTHORITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-26
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALN1401314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL01505OtherBCBS PROVIDER NUMBER
AL475333OSMedicaid
AL475333OSMedicaid