Provider Demographics
NPI:1750367538
Name:ALLEN MEMORIAL HOME
Entity type:Organization
Organization Name:ALLEN MEMORIAL HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-433-2642
Mailing Address - Street 1:735 S WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36603-1301
Mailing Address - Country:US
Mailing Address - Phone:251-433-2642
Mailing Address - Fax:251-433-5502
Practice Address - Street 1:735 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36603-1301
Practice Address - Country:US
Practice Address - Phone:251-433-2642
Practice Address - Fax:251-433-5502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-22
Last Update Date:2013-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10608314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4750980SMedicaid
AL10608OtherSTATE OF ALABAMA
AL1093540001Medicare NSC
AL10608OtherSTATE OF ALABAMA