Healthcare Provider Details

I. General information

NPI: 1962682633
Provider Name (Legal Business Name): COGBURN NURSING HOME INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2007
Last Update Date: 11/09/2007
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: 251-476-4700
  • Fax:
Mailing address:
  • Phone: 251-476-4700
  • 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. PRENTISS E SMITH
Title or Position: COO
Credential:
Phone: 251-476-4700