Provider Demographics
NPI:1851388318
Name:PIEDMONT HEALTH CARE CENTER
Entity Type:Organization
Organization Name:PIEDMONT HEALTH CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:KEENER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-447-8258
Mailing Address - Street 1:30 ROUNDTREE DR
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:AL
Mailing Address - Zip Code:36272-5892
Mailing Address - Country:US
Mailing Address - Phone:256-447-8258
Mailing Address - Fax:256-447-8230
Practice Address - Street 1:30 ROUNDTREE DR
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:AL
Practice Address - Zip Code:36272-5892
Practice Address - Country:US
Practice Address - Phone:256-447-8258
Practice Address - Fax:256-447-8230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-30
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10476314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4753400SMedicaid
AL1135740001Medicare NSC
AL015194Medicare Oscar/Certification