Healthcare Provider Details

I. General information

NPI: 1003504952
Provider Name (Legal Business Name): ARABELLA HEALTH & WELLNESS OF FAIRHOPE OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2023
Last Update Date: 08/28/2023
Certification Date: 08/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22670 MAIN ST
FAIRHOPE AL
36532-8301
US

IV. Provider business mailing address

22670 MAIN ST
FAIRHOPE AL
36532-8301
US

V. Phone/Fax

Practice location:
  • Phone: 251-928-2177
  • Fax: 251-928-2698
Mailing address:
  • Phone: 251-928-2177
  • Fax: 251-928-2698

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: CHAIM N HERTZEL
Title or Position: AUTHORIZED SIGNATORY
Credential:
Phone: 901-930-6124