Healthcare Provider Details

I. General information

NPI: 1811993181
Provider Name (Legal Business Name): USA HEALTHCARE WOODLAND VILLAGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 02/15/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 OLIVE ST SW
CULLMAN AL
35055-7202
US

IV. Provider business mailing address

1900 OLIVE ST SW
CULLMAN AL
35055-7202
US

V. Phone/Fax

Practice location:
  • Phone: 256-739-1430
  • Fax: 256-735-0708
Mailing address:
  • Phone: 256-739-1430
  • Fax: 256-735-0708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number10508
License Number StateAL

VII. Legacy identifiers

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

# 1
Identifier4757750S
Identifier TypeMEDICAID
Identifier StateAL
Identifier Issuer
# 2
Identifier010613
Identifier TypeOTHER
Identifier StateAL
Identifier IssuerBCBS PROVIDER NUMBER

VIII. Authorized Official

Name: MRS. EMILY HOLCOMB
Title or Position: ADMINISTRATOR
Credential:
Phone: 256-739-1430