Provider Demographics
NPI:1891790861
Name:EPISCOPAL FOUNDATION OF JEFFERSON COUNTY ST. MARTIN'S IN THE PINES
Entity Type:Organization
Organization Name:EPISCOPAL FOUNDATION OF JEFFERSON COUNTY ST. MARTIN'S IN THE PINES
Other - Org Name:ST. MARTIN'S IN THE PINES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:FAULKNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-314-4139
Mailing Address - Street 1:4941 MONTEVALLO RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35210-2418
Mailing Address - Country:US
Mailing Address - Phone:205-956-1831
Mailing Address - Fax:
Practice Address - Street 1:4941 MONTEVALLO RD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35210-2418
Practice Address - Country:US
Practice Address - Phone:205-956-1831
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10566314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
015433OtherMEDICARE PROVIDER #
AL4758000SMedicaid
AL4758000SMedicaid
AL4140240001Medicare NSC