MEDICARE: EIGHT MILE NURSING AND REHABILITATION CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	N4912	AL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	71-00009	OTHER	AL	MEDICARE COMPLETE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	00390	OTHER	AL	BC BS OF ALABAMA

General Provider Information

NPI Number	:	1033282215
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EIGHT MILE NURSING AND REHABILITATION CENTER, LLC

Provider Business Mailing Address
First Line	:	PO BOX 428
Second Line	:
City	:	ORCHARD PARK
State	:	NY
Zip	:	14127-0428
Country	:	US
Telephone Number	:	716-662-4955
Fax Number	:	716-667-9230

Provider Business Practice Location Address
First Line	:	4525 SAINT STEPHENS RD
Second Line	:
City	:	EIGHT MILE
State	:	AL
Zip	:	36613-3508
Country	:	US
Telephone Number	:	251-452-0996
Fax Number	:	251-456-2746

Authorized Official
Title or Position	:	CO-CHIEF EXECUTIVE OFFICER
Name	:	MR. NORBERT A BENNETT
Credential	:
Telephone Number	:	716-662-4955

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	12/11/2023

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