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General NPI Number Information
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NPI Number | 1043217375
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Entity Type | Organization
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Legal Business Name | WHEAT NURSING HOME INC
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Dates
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Enumeration Date | 07/01/2005
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Last Update Date | 04/30/2008
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Provider Practice Location Address
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Address Line | 703 17TH ST NW
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City | ALICEVILLE
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State | AL
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Zip | 35442-1426
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Country | US
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Telephone | 205-373-6307
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Fax | 205-373-2737
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Provider Business Mailing Address
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Address Line | 703 17TH ST NW
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City | ALICEVILLE
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State | AL
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Zip | 35442-1426
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Country | US
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Telephone | 205-373-6307
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Fax | 205-373-2737
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Authorized Official
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Title or Position | ADMINISTRATOR/OWNER
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Name | MR. MARK EVAN WHEAT
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Credential | LNHA
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Telephone | 205-373-6307
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 4754610S
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License Number State | AL
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