Healthcare Provider Details

I. General information

NPI: 1609872290
Provider Name (Legal Business Name): MAIN AND ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 03/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 SOUTHERN SPRINGS RD
UNION SPRINGS AL
36089-6643
US

IV. Provider business mailing address

745 SOUTHERN SPRINGS RD
UNION SPRINGS AL
36089-6643
US

V. Phone/Fax

Practice location:
  • Phone: 334-738-5590
  • Fax: 334-738-2460
Mailing address:
  • Phone: 334-738-5590
  • Fax: 334-738-2460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number10469
License Number StateAL

VIII. Authorized Official

Name: MRS. KRISTY TANNER
Title or Position: ADMINISTRATOR
Credential:
Phone: 334-738-5590