Provider Demographics
NPI:1609276245
Name:ROBERTSDALE NURSING HOME, INC.
Entity Type:Organization
Organization Name:ROBERTSDALE NURSING HOME, INC.
Other - Org Name:ROBERTSDALE OUTPATIENT REHABILITATION CLINC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CLARENCE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BALL
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:334-727-2944
Mailing Address - Street 1:602 AUBURN STREET
Mailing Address - Street 2:
Mailing Address - City:TUSKEGEE
Mailing Address - State:AL
Mailing Address - Zip Code:36083-1585
Mailing Address - Country:US
Mailing Address - Phone:334-727-2944
Mailing Address - Fax:
Practice Address - Street 1:18700 US HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:ROBERTSDALE
Practice Address - State:AL
Practice Address - Zip Code:36567-3271
Practice Address - Country:US
Practice Address - Phone:251-947-7243
Practice Address - Fax:251-947-7245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-02
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation