Provider Demographics
NPI:1336347277
Name:BAL, LLC
Entity Type:Organization
Organization Name:BAL, LLC
Other - Org Name:HANOVER HEALTH AND REHABILITATION AT BIRMINGHAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:M
Authorized Official - Last Name:WALCZAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-627-0664
Mailing Address - Street 1:2979 PGA BLVD
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-2911
Mailing Address - Country:US
Mailing Address - Phone:561-627-0664
Mailing Address - Fax:561-627-2867
Practice Address - Street 1:39 HANOVER CIR S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-1703
Practice Address - Country:US
Practice Address - Phone:205-933-1828
Practice Address - Fax:205-933-0900
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LP FACILITY VENTURES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-03
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALN3710314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL01-5423Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER