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General NPI Number Information
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NPI Number | 1184719247
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Entity Type | Organization
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Legal Business Name | HERITAGE HEALTH CARE & REHAB, INC.
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1101 SNOWS MILL AVENUE
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City | TUSCALOOSA
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State | AL
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Zip | 35406-2015
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Country | US
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Telephone | 205-759-5179
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Fax | 205-759-5216
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Provider Business Mailing Address
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Address Line | 1101 SNOWS MILL AVENUE
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City | TUSCALOOSA
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State | AL
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Zip | 35406-2015
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Country | US
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Telephone | 205-759-5179
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Fax | 205-759-5216
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. GEORGE L JACKSON
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Credential |
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Telephone | 205-759-5179
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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 | 12691
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License Number State | AL
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