Healthcare Provider Details

I. General information

NPI: 1497113740
Provider Name (Legal Business Name): NOLAND EASTERN SHORE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2016
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 VILLA DR
DAPHNE AL
36526-4653
US

IV. Provider business mailing address

600 CORPORATE PKWY SUITE 100
BIRMINGHAM AL
35242-5451
US

V. Phone/Fax

Practice location:
  • Phone: 251-626-2694
  • Fax:
Mailing address:
  • Phone: 205-783-8460
  • Fax: 205-783-8441

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: NICHOLAS V RENDA
Title or Position: EVP/CFO
Credential:
Phone: 205-783-8460