Provider Demographics
NPI:1881748556
Name:EL REPOSO NURSING FACILITY
Entity type:Organization
Organization Name:EL REPOSO NURSING FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HORTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-757-2143
Mailing Address - Street 1:260 MILNERS CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35634-4757
Mailing Address - Country:US
Mailing Address - Phone:256-757-2143
Mailing Address - Fax:888-612-8092
Practice Address - Street 1:260 MILNERS CHAPEL RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35634-4757
Practice Address - Country:US
Practice Address - Phone:256-757-2143
Practice Address - Fax:888-612-8092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALN3901314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4752100SMedicaid
AL4752100SMedicaid
AL015402Medicare ID - Type UnspecifiedPROVIDER NUMBER