Healthcare Provider Details

I. General information

NPI: 1932156775
Provider Name (Legal Business Name): CORDOVA HEALTH AND REHABILITATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 10/12/2020
Certification Date: 10/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 HIGHLAND ST W
CORDOVA AL
35550-1416
US

IV. Provider business mailing address

70 HIGHLAND ST W
CORDOVA AL
35550-1416
US

V. Phone/Fax

Practice location:
  • Phone: 205-483-9282
  • Fax:
Mailing address:
  • Phone: 205-483-9282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier4754000S
Identifier TypeMEDICAID
Identifier StateAL
Identifier Issuer
# 2
Identifier012593
Identifier TypeOTHER
Identifier StateAL
Identifier IssuerBCBS ID

VIII. Authorized Official

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