Provider Demographics
NPI:1497117279
Name:PROHEALTH LTC-TRUSSVILLE LLC
Entity Type:Organization
Organization Name:PROHEALTH LTC-TRUSSVILLE LLC
Other - Org Name:TRUSSVILLE HEALTH & REHAB CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:LESTER
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:205-820-7000
Mailing Address - Street 1:717 37TH ST S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35222-3244
Mailing Address - Country:US
Mailing Address - Phone:205-341-7300
Mailing Address - Fax:855-301-9880
Practice Address - Street 1:119 WATTERSON PKWY
Practice Address - Street 2:
Practice Address - City:TRUSSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35173-2307
Practice Address - Country:US
Practice Address - Phone:205-655-3226
Practice Address - Fax:205-661-2366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-22
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL191841Medicaid
AL015467Medicare Oscar/Certification