Healthcare Provider Details

I. General information

NPI: 1568367761
Provider Name (Legal Business Name): PROVIDENCE PARK REHABILITATION HEALTHCARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 PROVIDENCE PARK DRIVE EAST
MOBILE AL
36695
US

IV. Provider business mailing address

550 PROVIDENCE PARK DRIVE EAST
MOBILE AL
36695
US

V. Phone/Fax

Practice location:
  • Phone: 251-433-9801
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateNULL

VIII. Authorized Official

Name: CLARENCE BALL
Title or Position: CEO
Credential:
Phone: 251-433-9801