Organization
SHADESCREST HEALTH CARE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOE B HAVENS (ADMINISTRATOR)
(205) 384-9086
Entity
Organization
Contact information
Practice address
331 25TH ST W, JASPER, AL 35501-5828
(205) 384-9086
(205) 387-2225
Mailing address
331 25TH ST W, P.O. BOX 1012, JASPER, AL 35501-5828
(205) 384-9086
(205) 387-2225
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
10671
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4754101S
—
AL
Enumeration date
10/05/2005
Last updated
01/19/2022
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