Provider Demographics
NPI:1609872290
Name:MAIN AND ASSOCIATES INC
Entity Type:Organization
Organization Name:MAIN AND ASSOCIATES INC
Other - Org Name:SOUTHERN SPRINGS HEALTHCARE FACILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:TANNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-738-5590
Mailing Address - Street 1:745 SOUTHERN SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:UNION SPRINGS
Mailing Address - State:AL
Mailing Address - Zip Code:36089-6643
Mailing Address - Country:US
Mailing Address - Phone:334-738-5590
Mailing Address - Fax:334-738-2460
Practice Address - Street 1:745 SOUTHERN SPRINGS RD
Practice Address - Street 2:
Practice Address - City:UNION SPRINGS
Practice Address - State:AL
Practice Address - Zip Code:36089-6643
Practice Address - Country:US
Practice Address - Phone:334-738-5590
Practice Address - Fax:334-738-2460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-28
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10469314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL010587OtherBLUE CROSS BLUE SHIELD
AL4753450SMedicaid
AL009812400Medicaid
AL009812400Medicaid