Provider Demographics
NPI:1558356303
Name:ATTALLA NURSING ADK, LLC
Entity Type:Organization
Organization Name:ATTALLA NURSING ADK, LLC
Other - Org Name:ATTALLA HEALTH CARE, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBENSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-869-5116
Mailing Address - Street 1:915 STEWART AVE SE
Mailing Address - Street 2:
Mailing Address - City:ATTALLA
Mailing Address - State:AL
Mailing Address - Zip Code:35954-3610
Mailing Address - Country:US
Mailing Address - Phone:256-538-7852
Mailing Address - Fax:256-538-7857
Practice Address - Street 1:915 STEWART AVE SE
Practice Address - Street 2:
Practice Address - City:ATTALLA
Practice Address - State:AL
Practice Address - Zip Code:35954-3610
Practice Address - Country:US
Practice Address - Phone:256-538-7852
Practice Address - Fax:256-538-7857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-19
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4754040SMedicaid
AL015203Medicare Oscar/Certification