Healthcare Provider Details

I. General information

NPI: 1568438240
Provider Name (Legal Business Name): COGBURN HEALTH AND REHABILITATION - WEST, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 09/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8002 GRELOT RD
MOBILE AL
36695-8976
US

IV. Provider business mailing address

8002 GRELOT RD
MOBILE AL
36695-8976
US

V. Phone/Fax

Practice location:
  • Phone: 251-634-8002
  • Fax:
Mailing address:
  • Phone: 251-634-8002
  • 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: MR. MATTHEW B KENDRICK
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 251-476-4700