Healthcare Provider Details

I. General information

NPI: 1013941764
Provider Name (Legal Business Name): MONROE MANOR NURSING HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 03/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 W CLAIBORNE ST
MONROEVILLE AL
36460-1704
US

IV. Provider business mailing address

1 SOUTHERN WAY
MOBILE AL
36619-1210
US

V. Phone/Fax

Practice location:
  • Phone: 251-575-2648
  • Fax: 251-575-2647
Mailing address:
  • Phone: 251-433-9801
  • Fax: 251-433-9807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number12646
License Number StateAL

VIII. Authorized Official

Name: MR. ZED D PERRIGIN
Title or Position: ADMINISTRATOR
Credential:
Phone: 251-575-2648