Provider Demographics
NPI:1962682633
Name:COGBURN NURSING HOME INC
Entity Type:Organization
Organization Name:COGBURN NURSING HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:PRENTISS
Authorized Official - Middle Name:E
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-476-4700
Mailing Address - Street 1:148 TUSCALOOSA ST
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36607-3408
Mailing Address - Country:US
Mailing Address - Phone:251-476-4700
Mailing Address - Fax:
Practice Address - Street 1:148 TUSCALOOSA ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36607-3408
Practice Address - Country:US
Practice Address - Phone:251-476-4700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility