Provider Demographics
NPI:1396735965
Name:COGBURN HEALTH & REHABILITATION-MIDTOWN, INC.
Entity type:Organization
Organization Name:COGBURN HEALTH & REHABILITATION-MIDTOWN, INC.
Other - Org Name:<UNAVAIL>
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 1:2651 CAMERON ST STE D
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36607-3127
Mailing Address - Country:US
Mailing Address - Phone:251-450-2800
Mailing Address - Fax:251-476-7124
Practice Address - Street 1:3104 DAUPHIN SQ CONNECTOR
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36607-2513
Practice Address - Country:US
Practice Address - Phone:251-450-2800
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:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL016981314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL016981OtherLICENSE NUMBER
AL016981OtherLICENSE NUMBER
AL015403Medicare Oscar/Certification