Provider Demographics
NPI:1700992690
Name:HENRY COUNTY NURSING HOME
Entity Type:Organization
Organization Name:HENRY COUNTY NURSING HOME
Other - Org Name:HENRY COUNTY HEALTH AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERRI
Authorized Official - Middle Name:T
Authorized Official - Last Name:GILMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-585-2241
Mailing Address - Street 1:212 DOTHAN ROAD
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36310
Mailing Address - Country:US
Mailing Address - Phone:334-585-2241
Mailing Address - Fax:334-585-5082
Practice Address - Street 1:212 DOTHAN ROAD
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:AL
Practice Address - Zip Code:36310
Practice Address - Country:US
Practice Address - Phone:334-585-2241
Practice Address - Fax:334-585-5082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALN3401314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4757620SMedicaid
AL015373Medicare Oscar/Certification