Healthcare Provider Details

I. General information

NPI: 1083560072
Provider Name (Legal Business Name): VINSON ROAD HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2026
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 10TH AVE NW
RED BAY AL
35582-3800
US

IV. Provider business mailing address

106 10TH AVE NW
RED BAY AL
35582-3800
US

V. Phone/Fax

Practice location:
  • Phone: 256-356-4982
  • Fax: 256-356-8400
Mailing address:
  • Phone: 256-356-4982
  • Fax: 256-356-8400

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: SOON BURNAM
Title or Position: SECRETARY
Credential:
Phone: 949-540-1249