Provider Demographics
NPI:1013941764
Name:MONROE MANOR NURSING HOME LLC
Entity Type:Organization
Organization Name:MONROE MANOR NURSING HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ZED
Authorized Official - Middle Name:D
Authorized Official - Last Name:PERRIGIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-575-2648
Mailing Address - Street 1:1 SOUTHERN WAY
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36619-1210
Mailing Address - Country:US
Mailing Address - Phone:251-433-9801
Mailing Address - Fax:251-433-9807
Practice Address - Street 1:236 W CLAIBORNE ST
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:AL
Practice Address - Zip Code:36460-1704
Practice Address - Country:US
Practice Address - Phone:251-575-2648
Practice Address - Fax:251-575-2647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12646314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4757130SMedicaid
AL4757130SMedicaid
AL015398Medicare Oscar/Certification