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General NPI Number Information
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NPI Number | 1548293525
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Entity Type | Organization
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Legal Business Name | SALEM NURSING & REHAB CENTER OF REFORM, INC.
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 06/16/2014
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Provider Practice Location Address
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Address Line | 512 2ND AVE NW
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City | REFORM
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State | AL
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Zip | 35481-2332
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Country | US
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Telephone | 205-375-6379
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Fax | 205-375-8283
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Provider Business Mailing Address
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Address Line | 512 2ND AVE NW
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City | REFORM
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State | AL
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Zip | 35481-2332
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Country | US
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Telephone | 205-375-6379
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Fax | 205-375-8283
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. DOUGLAS K MITTLEIDER
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Credential |
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Telephone | 770-619-0866
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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 | 12664
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License Number State | AL
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