Provider Demographics
NPI:1942921978
Name:ARABELLA HEALTH AND WELLNESS OF PHENIX CITY LLC
Entity Type:Organization
Organization Name:ARABELLA HEALTH AND WELLNESS OF PHENIX CITY LLC
Other - Org Name:EAST VILLAGE NURSING AND REHAB OPCO LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAIM
Authorized Official - Middle Name:N
Authorized Official - Last Name:HERTZEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-930-6124
Mailing Address - Street 1:3440 HOLLYWOOD BLVD STE 415
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6933
Mailing Address - Country:US
Mailing Address - Phone:901-930-6124
Mailing Address - Fax:
Practice Address - Street 1:3900 LAKEWOOD DR
Practice Address - Street 2:
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36867-2448
Practice Address - Country:US
Practice Address - Phone:334-298-8247
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-07
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility