Healthcare Provider Details

I. General information

NPI: 1548293525
Provider Name (Legal Business Name): SALEM NURSING & REHAB CENTER OF REFORM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 06/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 2ND AVE NW
REFORM AL
35481-2332
US

IV. Provider business mailing address

512 2ND AVE NW
REFORM AL
35481-2332
US

V. Phone/Fax

Practice location:
  • Phone: 205-375-6379
  • Fax: 205-375-8283
Mailing address:
  • Phone: 205-375-6379
  • Fax: 205-375-8283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number12664
License Number StateAL

VIII. Authorized Official

Name: MR. DOUGLAS K MITTLEIDER
Title or Position: PRESIDENT
Credential:
Phone: 770-619-0866