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General NPI Number Information
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NPI Number | 1326120502
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Entity Type | Organization
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Legal Business Name | RUSSELLVILLE HEALTH CARE, LLC
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Dates
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Enumeration Date | 10/19/2006
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Last Update Date | 08/26/2022
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Provider Practice Location Address
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Address Line | 705 GANDY ST NE
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City | RUSSELLVILLE
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State | AL
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Zip | 35653-1913
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Country | US
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Telephone | 256-332-3773
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Fax | 256-332-1292
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Provider Business Mailing Address
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Address Line | 705 GANDY ST NE
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City | RUSSELLVILLE
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State | AL
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Zip | 35653-1913
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Country | US
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Telephone | 256-332-3773
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Fax | 256-332-1292
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Authorized Official
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Title or Position | NURSING HOME ADMINISTRATOR
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Name | MRS. BRENDA GAIL HOVATER
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Credential |
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Telephone | 256-332-3773
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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 | 12541
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License Number State | AL
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