Healthcare Provider Details

I. General information

NPI: 1750367538
Provider Name (Legal Business Name): ALLEN MEMORIAL HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 09/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 S WASHINGTON AVE
MOBILE AL
36603-1301
US

IV. Provider business mailing address

735 S WASHINGTON AVE
MOBILE AL
36603-1301
US

V. Phone/Fax

Practice location:
  • Phone: 251-433-2642
  • Fax: 251-433-5502
Mailing address:
  • Phone: 251-433-2642
  • Fax: 251-433-5502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number10608
License Number StateAL

VIII. Authorized Official

Name: CHERYL A ROBINSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 251-433-2642