Provider Demographics
NPI:1396338950
Name:COTTAGES RUSSELLVILLE, LLC
Entity type:Organization
Organization Name:COTTAGES RUSSELLVILLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:WESTLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-929-7536
Mailing Address - Street 1:900 JACKSON AVE N
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35653-1627
Mailing Address - Country:US
Mailing Address - Phone:256-332-4707
Mailing Address - Fax:
Practice Address - Street 1:900 JACKSON AVE N
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AL
Practice Address - Zip Code:35653-1627
Practice Address - Country:US
Practice Address - Phone:256-332-4707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-15
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility