Healthcare Provider Details

I. General information

NPI: 1710938998
Provider Name (Legal Business Name): SHELBY RIDGE ACQUISITION CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2006
Last Update Date: 01/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

881 3RD ST NE
ALABASTER AL
35007-8954
US

IV. Provider business mailing address

881 3RD ST NE
ALABASTER AL
35007-8954
US

V. Phone/Fax

Practice location:
  • Phone: 205-620-8500
  • Fax: 205-620-8553
Mailing address:
  • Phone: 205-620-8500
  • Fax: 205-620-8553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number12676
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MRS. TAMMY MOCK STEPHENSON
Title or Position: CFO
Credential:
Phone: 334-273-9002