Provider Demographics
NPI:1427045673
Name:SUMMERFORD NURSING HOME, INC.
Entity Type:Organization
Organization Name:SUMMERFORD NURSING HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:SUMMERFORD
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:256-784-5275
Mailing Address - Street 1:4087 HIGHWAY 31 SW
Mailing Address - Street 2:
Mailing Address - City:FALKVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35622-6319
Mailing Address - Country:US
Mailing Address - Phone:256-784-5275
Mailing Address - Fax:256-784-5852
Practice Address - Street 1:4087 HIGHWAY 31 SW
Practice Address - Street 2:
Practice Address - City:FALKVILLE
Practice Address - State:AL
Practice Address - Zip Code:35622-6319
Practice Address - Country:US
Practice Address - Phone:256-784-5275
Practice Address - Fax:256-784-5852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7119207R00000X
AL01D0641594291U00000X
AL10634314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4750750SMedicaid
AL4750750SMedicaid