Provider Demographics
NPI:1932156775
Name:CORDOVA HEALTH AND REHABILITATION, LLC
Entity Type:Organization
Organization Name:CORDOVA HEALTH AND REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:CODY
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-391-3600
Mailing Address - Street 1:70 HIGHLAND ST W
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:AL
Mailing Address - Zip Code:35550-1416
Mailing Address - Country:US
Mailing Address - Phone:205-483-9282
Mailing Address - Fax:
Practice Address - Street 1:70 HIGHLAND ST W
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:AL
Practice Address - Zip Code:35550-1416
Practice Address - Country:US
Practice Address - Phone:205-483-9282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4754000SMedicaid
AL012593OtherBCBS ID
015115Medicare Oscar/Certification