Organization
PHOENIX HEALTHCARE LLC
Active
Other names
Traylor Nursing Home, Inc
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RONALD TRAYLOR (ADMINISTRATOR)
(334) 863-3500
Entity
Organization
Contact information
Practice address
1235 YANCEY ST, ROANOKE, AL 36274-2141
(334) 863-3500
(334) 863-3531
Mailing address
PO BOX 467, 1235 YANCEY STREET, ROANOKE, AL 36274-0467
(334) 863-3500
(334) 863-3531
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
10641
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
021561
BLUE CROSS BLUE SHIELD
AL
05
—
4752240S
—
AL
Enumeration date
05/15/2006
Last updated
12/20/2011
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