Provider Demographics
NPI:1598750994
Name:LAUDERDALE CHRISTIAN NURSING HOME
Entity Type:Organization
Organization Name:LAUDERDALE CHRISTIAN NURSING HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MORROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-757-2103
Mailing Address - Street 1:2019 COUNTY ROAD 394
Mailing Address - Street 2:
Mailing Address - City:KILLEN
Mailing Address - State:AL
Mailing Address - Zip Code:35645-5525
Mailing Address - Country:US
Mailing Address - Phone:256-757-2103
Mailing Address - Fax:256-757-2233
Practice Address - Street 1:2019 COUNTY ROAD 394
Practice Address - Street 2:
Practice Address - City:KILLEN
Practice Address - State:AL
Practice Address - Zip Code:35645-5525
Practice Address - Country:US
Practice Address - Phone:256-757-2103
Practice Address - Fax:256-757-2233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-13
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10580314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4753610SMedicaid
AL015361Medicare ID - Type Unspecified