Healthcare Provider Details

I. General information

NPI: 1649260225
Provider Name (Legal Business Name): COGBURN HEALTH & REHABILITATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 04/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 TUSCALOOSA ST
MOBILE AL
36607-3408
US

IV. Provider business mailing address

148 TUSCALOOSA ST
MOBILE AL
36607-3408
US

V. Phone/Fax

Practice location:
  • Phone: 251-471-5431
  • Fax: 251-476-7124
Mailing address:
  • Phone: 251-471-5431
  • Fax: 251-476-7124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number103749
License Number StateAL

VIII. Authorized Official

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