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NPI Code Detail

MEDICARE: CLOVERDALE HEALTH CARE, INC.

MEDICARE: CLOVERDALE HEALTH CARE, INC.
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
1314000000XSkilled Nursing Facility10541AL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2011620OTHERALBLUE CROSS BLUE SHIELD AL

General Provider Information

NPI Number : 1922004811
Entity Type Code : Organization
Provider Name (Legal Business Name) : CLOVERDALE HEALTH CARE, INC.
Provider Business Mailing Address
First Line : 412 W CLOVERDALE RD
Second Line :
City : SCOTTSBORO
State : AL
Zip : 35768-4264
Country : US
Telephone Number : 256-259-1505
Fax Number : 256-259-4279
Provider Business Practice Location Address
First Line : 412 W CLOVERDALE RD
Second Line :
City : SCOTTSBORO
State : AL
Zip : 35768-4264
Country : US
Telephone Number : 256-259-1505
Fax Number : 256-259-4279
Authorized Official
Title or Position : ADMINISTRATOR
Name : MRS. KRISTY A JONES
Credential : LNHA
Telephone Number : 256-259-1505
Provider Enumeration Date : 06/24/2005
Last Update Date : 06/06/2017

Similar Medicare Providers

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Practice Location Address:
412 W CLOVERDALE RD
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Practice Fax:
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1003392002 — MARLA BYRUM NP
Practice Location Address:
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Practice Fax:
1134722861 — MRS. HANNAH REBECCA BLACK MS CCC-SLP
Practice Location Address:
412 W CLOVERDALE RD
SCOTTSBORO, AL
35768-4264
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Practice Fax:
1235705088 — KENNEDY GEORGE
Practice Location Address:
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Practice Fax:
1750041786 — HIGHLANDS PROFESSIONAL SERVICES
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408 TAYLOR ST
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Directions to “CLOVERDALE HEALTH CARE, INC. ” Practice Location

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