Provider Demographics
NPI:1598159501
Name:RANDOLPH MANAGEMENT COMPANY, INC.
Entity type:Organization
Organization Name:RANDOLPH MANAGEMENT COMPANY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:TRAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-749-1471
Mailing Address - Street 1:1235 YANCEY ST
Mailing Address - Street 2:P.O. BOX 467
Mailing Address - City:ROANOKE
Mailing Address - State:AL
Mailing Address - Zip Code:36274-2141
Mailing Address - Country:US
Mailing Address - Phone:334-863-3500
Mailing Address - Fax:334-863-2325
Practice Address - Street 1:1235 YANCEY ST
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:AL
Practice Address - Zip Code:36274-2141
Practice Address - Country:US
Practice Address - Phone:334-863-3500
Practice Address - Fax:334-863-2325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-27
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALN5603314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility