Provider Demographics
NPI:1922111004
Name:UNION LTC, INC
Entity Type:Organization
Organization Name:UNION LTC, INC
Other - Org Name:NEW ALBANY HEALTH & REHAB CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GENE
Authorized Official - Middle Name:BENNETT
Authorized Official - Last Name:HUBBARD
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:601-849-2294
Mailing Address - Street 1:118 S GLENFIELD RD
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:MS
Mailing Address - Zip Code:38652-2605
Mailing Address - Country:US
Mailing Address - Phone:662-534-9506
Mailing Address - Fax:662-534-2407
Practice Address - Street 1:118 S GLENFIELD RD
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:MS
Practice Address - Zip Code:38652-2605
Practice Address - Country:US
Practice Address - Phone:662-534-9506
Practice Address - Fax:662-534-2407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS266314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00230076Medicaid
MS00230076Medicaid