=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356441257
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAMDEN NURSING FACILITY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/22/2006
-----------------------------------------------------
Last Update Date | 03/05/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 550 PONDEROSA DR
-----------------------------------------------------
City | CAMDEN
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36726-0787
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-682-4231
-----------------------------------------------------
Fax | 334-682-5224
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 550 PONDEROSA DR P.O. BOX 787
-----------------------------------------------------
City | CAMDEN
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36726-0787
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-682-4231
-----------------------------------------------------
Fax | 334-682-5224
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MR. ELDRIDGE B STEWART
-----------------------------------------------------
Credential | ADMINISTRATOR
-----------------------------------------------------
Telephone | 334-682-4231
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251J00000X
-----------------------------------------------------
Taxonomy Name | Nursing Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------