Provider Demographics
NPI:1295725877
Name:COGBURN HEALTH & REHABILITATION-HUNTSVILLE, INC.
Entity type:Organization
Organization Name:COGBURN HEALTH & REHABILITATION-HUNTSVILLE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:PRENTISS
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-476-4700
Mailing Address - Street 1:4010 CHRIS DR SW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802-4189
Mailing Address - Country:US
Mailing Address - Phone:256-883-8656
Mailing Address - Fax:251-476-7124
Practice Address - Street 1:4010 CHRIS DR SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802-4189
Practice Address - Country:US
Practice Address - Phone:256-883-8656
Practice Address - Fax:251-476-7124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-25
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL004924314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL004924OtherLICENSE NUMBER
AL004924OtherLICENSE NUMBER
AL015440Medicare Oscar/Certification