Provider Demographics
NPI:1497113740
Name:NOLAND EASTERN SHORE, LLC
Entity Type:Organization
Organization Name:NOLAND EASTERN SHORE, LLC
Other - Org Name:EASTERN SHORE REHABILITATION AND HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, REGULATORY AFFAIRS
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:E
Authorized Official - Last Name:ESTEP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-783-8444
Mailing Address - Street 1:600 CORPORATE PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5451
Mailing Address - Country:US
Mailing Address - Phone:205-783-8460
Mailing Address - Fax:205-783-8441
Practice Address - Street 1:101 VILLA DR
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-4653
Practice Address - Country:US
Practice Address - Phone:251-626-2694
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-02
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
015049Medicare Oscar/Certification