Provider Demographics
NPI:1790855211
Name:ALICE M KIDD NURSING FACILITY
Entity Type:Organization
Organization Name:ALICE M KIDD NURSING FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACILITY DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NEDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MONCRIEF-CRAIG
Authorized Official - Suffix:
Authorized Official - Credentials:FACILITY DIRECTOR
Authorized Official - Phone:205-759-0633
Mailing Address - Street 1:PO BOX 20707
Mailing Address - Street 2:200 UNIVERSITY BLVD
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35402-0707
Mailing Address - Country:US
Mailing Address - Phone:205-759-0633
Mailing Address - Fax:205-759-0133
Practice Address - Street 1:200 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35402-0707
Practice Address - Country:US
Practice Address - Phone:205-759-0633
Practice Address - Fax:205-759-0133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL47577705Medicaid