Healthcare Provider Details

I. General information

NPI: 1033200068
Provider Name (Legal Business Name): PLEASANT GROVE NURSING AND REHABILITATION CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 7TH ST
PLEASANT GROVE AL
35127-1962
US

IV. Provider business mailing address

30 7TH ST
PLEASANT GROVE AL
35127-1962
US

V. Phone/Fax

Practice location:
  • Phone: 205-744-8226
  • Fax: 205-744-8211
Mailing address:
  • Phone: 205-744-8226
  • Fax: 205-744-8211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number12574
License Number StateAL

VIII. Authorized Official

Name: MR. NORBERT A BENNETT
Title or Position: CO-CEO
Credential:
Phone: 716-662-4955