Provider Demographics
NPI:1508021122
Name:ASHVILLE MANOR NURSING HOME
Entity Type:Organization
Organization Name:ASHVILLE MANOR NURSING HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TEDDY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-638-8479
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:ASHVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35953-0130
Mailing Address - Country:US
Mailing Address - Phone:205-594-5148
Mailing Address - Fax:205-594-4507
Practice Address - Street 1:38286 US HIGHWAY 231
Practice Address - Street 2:
Practice Address - City:ASHVILLE
Practice Address - State:AL
Practice Address - Zip Code:35953-7338
Practice Address - Country:US
Practice Address - Phone:205-594-5148
Practice Address - Fax:205-594-4507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-23
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12672314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL015407Medicare Oscar/Certification