MEDICARE: SOUTH HAVEN HEALTH AND REHABILITATION, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	012650	OTHER	AL	BCBS ID
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083661821
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH HAVEN HEALTH AND REHABILITATION, LLC

Provider Business Mailing Address
First Line	:	3141 OLD COLUMBIANA RD
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35226-3703
Country	:	US
Telephone Number	:	205-822-1580
Fax Number	:

Provider Business Practice Location Address
First Line	:	3141 OLD COLUMBIANA RD
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35226-3703
Country	:	US
Telephone Number	:	205-822-1580
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	PHILLIP CODY LONG
Credential	:
Telephone Number	:	205-391-3600

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	10/28/2020

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