Provider Demographics
NPI:1538188719
Name:ANDALUSIA HEALTH CARE LLC
Entity type:Organization
Organization Name:ANDALUSIA HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSING HOME ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TRECE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-222-2101
Mailing Address - Street 1:PO BOX 1395
Mailing Address - Street 2:
Mailing Address - City:ANDALUSIA
Mailing Address - State:AL
Mailing Address - Zip Code:36420-1224
Mailing Address - Country:US
Mailing Address - Phone:334-222-2101
Mailing Address - Fax:334-222-5653
Practice Address - Street 1:200 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:ANDALUSIA
Practice Address - State:AL
Practice Address - Zip Code:36420-2527
Practice Address - Country:US
Practice Address - Phone:334-222-2101
Practice Address - Fax:334-222-5653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00383314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4750820SMedicaid
AL015082Medicare ID - Type Unspecified