Healthcare Provider Details

I. General information

NPI: 1134176795
Provider Name (Legal Business Name): COLUMBIANA HEALTH AND REHABILITATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 10/28/2020
Certification Date: 10/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22969 HIGHWAY 25
COLUMBIANA AL
35051-3502
US

IV. Provider business mailing address

22969 HIGHWAY 25
COLUMBIANA AL
35051-3502
US

V. Phone/Fax

Practice location:
  • Phone: 205-669-1712
  • Fax: 205-669-6169
Mailing address:
  • Phone: 205-669-1712
  • Fax: 205-669-6169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: PHILLIP CODY LONG
Title or Position: CFO
Credential:
Phone: 205-391-3600