MEDICARE: GREENBRIAR AT THE ALTAMONT, 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	310400000X	Assisted Living Facility	10295	AL
2	314000000X	Skilled Nursing Facility	10548	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962409797
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREENBRIAR AT THE ALTAMONT, LLC

Provider Business Mailing Address
First Line	:	600 CORPORATE PKWY STE 100
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35242-2934
Country	:	US
Telephone Number	:	205-783-8472
Fax Number	:	204-783-8441

Provider Business Practice Location Address
First Line	:	2831 HIGHLAND AVE S
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35205-1801
Country	:	US
Telephone Number	:	205-323-2724
Fax Number	:	205-714-3195

Authorized Official
Title or Position	:	EVP/CFO
Name	:	NICHOLAS V RENDA
Credential	:
Telephone Number	:	205-783-8460

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	11/12/2024

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