Provider Demographics
NPI:1609958206
Name:ALBERTVILLE HEALTHCARE CENTER, INC.
Entity Type:Organization
Organization Name:ALBERTVILLE HEALTHCARE CENTER, INC.
Other - Org Name:ALBERTVILLE NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN OF THE BOARD
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATTI
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-273-9002
Mailing Address - Street 1:750 AL HIGHWAY 75 N
Mailing Address - Street 2:
Mailing Address - City:ALBERTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35951-4014
Mailing Address - Country:US
Mailing Address - Phone:256-878-1398
Mailing Address - Fax:256-878-6949
Practice Address - Street 1:750 AL HIGHWAY 75 N
Practice Address - Street 2:
Practice Address - City:ALBERTVILLE
Practice Address - State:AL
Practice Address - Zip Code:35951-4014
Practice Address - Country:US
Practice Address - Phone:256-878-1398
Practice Address - Fax:256-878-6949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12623314000000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL47-51240SMedicaid
01-5163Medicare ID - Type Unspecified
015163Medicare Oscar/Certification
5582710001Medicare NSC