Healthcare Provider Details

I. General information

NPI: 1720837966
Provider Name (Legal Business Name): NOLAND EXTENDICARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2024
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 S SAINT ANDREWS ST
DOTHAN AL
36301-3684
US

IV. Provider business mailing address

600 CORPORATE PKWY STE 100
HOOVER AL
35242-5451
US

V. Phone/Fax

Practice location:
  • Phone: 334-793-1177
  • Fax:
Mailing address:
  • Phone: 205-783-8460
  • Fax:

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