Healthcare Provider Details

I. General information

NPI: 1396735965
Provider Name (Legal Business Name): COGBURN HEALTH & REHABILITATION-MIDTOWN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 08/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3104 DAUPHIN SQ CONNECTOR
MOBILE AL
36607-2513
US

IV. Provider business mailing address

2651 CAMERON ST STE D
MOBILE AL
36607-3127
US

V. Phone/Fax

Practice location:
  • Phone: 251-450-2800
  • Fax: 251-476-7124
Mailing address:
  • Phone: 251-450-2800
  • Fax: 251-476-7124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number016981
License Number StateAL

VIII. Authorized Official

Name: MR. PRENTISS SMITH
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 251-476-4700