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General NPI Number Information
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NPI Number | 1770769119
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Entity Type | Organization
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Legal Business Name | KNOLLWOOD HEALTHCARE LLC
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Dates
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Enumeration Date | 01/16/2008
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Last Update Date | 02/27/2008
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Provider Practice Location Address
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Address Line | 3151 KNOLLWOOD DR # A
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City | MOBILE
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State | AL
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Zip | 36693-2753
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Country | US
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Telephone | 251-661-7608
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Fax |
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Provider Business Mailing Address
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Address Line | 3151 KNOLLWOOD DR # A
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City | MOBILE
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State | AL
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Zip | 36693-2753
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Country | US
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Telephone | 251-661-7608
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | TYGH BROGDON
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Credential |
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Telephone | 770-650-8773
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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 | N4926
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License Number State | AL
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