Healthcare Provider Details

I. General information

NPI: 1851790844
Provider Name (Legal Business Name): 211 213 ANA DRIVE OPERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2014
Last Update Date: 12/10/2021
Certification Date: 12/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 ANA DR
FLORENCE AL
35630-1768
US

IV. Provider business mailing address

211 ANA DR
FLORENCE AL
35630-1768
US

V. Phone/Fax

Practice location:
  • Phone: 256-766-8963
  • Fax: 256-766-8954
Mailing address:
  • Phone: 256-766-8963
  • Fax: 256-766-8954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number0000001
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number16107
License Number StateAL

VIII. Authorized Official

Name: MICHAEL T. BERG
Title or Position: ASSISTANT SECRETARY
Credential:
Phone: 505-468-4752