Provider Demographics
NPI:1295722882
Name:MITCHELL-HOLLINGSWORTH NURSING & REHAB CENTER
Entity type:Organization
Organization Name:MITCHELL-HOLLINGSWORTH NURSING & REHAB CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/MEDICAL RECORDS
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:RHIT
Authorized Official - Phone:256-740-5400
Mailing Address - Street 1:805 FLAGG CIR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-3362
Mailing Address - Country:US
Mailing Address - Phone:256-740-5400
Mailing Address - Fax:256-740-5471
Practice Address - Street 1:805 FLAGG CIR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-3362
Practice Address - Country:US
Practice Address - Phone:256-740-5400
Practice Address - Fax:256-740-5471
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MITCHELL-HOLLINGSWORTH NURSING AND REHAB
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-09-29
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10581314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4750330SMedicaid
AL4750330SMedicaid