Provider Demographics
NPI:1598752073
Name:SOUTH HAMPTON NURSING AND REHABILITATION CENTER, LLC
Entity Type:Organization
Organization Name:SOUTH HAMPTON NURSING AND REHABILITATION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL ACCT.
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONTE
Authorized Official - Middle Name:S
Authorized Official - Last Name:STICKLER
Authorized Official - Suffix:
Authorized Official - Credentials:CORPORATE ACCT
Authorized Official - Phone:256-677-3819
Mailing Address - Street 1:213 WILSON MANN RD
Mailing Address - Street 2:
Mailing Address - City:OWENS CROSS ROADS
Mailing Address - State:AL
Mailing Address - Zip Code:35763-8606
Mailing Address - Country:US
Mailing Address - Phone:256-725-3400
Mailing Address - Fax:256-725-3423
Practice Address - Street 1:213 WILSON MANN RD
Practice Address - Street 2:
Practice Address - City:OWENS CROSS ROADS
Practice Address - State:AL
Practice Address - Zip Code:35763-8606
Practice Address - Country:US
Practice Address - Phone:256-725-3400
Practice Address - Fax:256-725-3423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-30
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10596314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4758120SMedicaid
AL015448Medicare Oscar/Certification