Organization
ATHENS CONVALESCENT CENTER
Active
Other names
Athens Nursing Home
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN WALLACE (ADMINISTRATOR)
(256) 232-1620
Entity
Organization
Contact information
Practice address
611 W MARKET ST, ATHENS, AL 35611-2460
(256) 232-1620
(256) 232-2017
Mailing address
611 W MARKET ST, ATHENS, AL 35611-2460
(256) 232-1620
(256) 232-2017
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
54038
AL
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
N4201
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
015016
MEDICARE PART A PROVIDER
AL
05
—
4757080S
—
AL
Enumeration date
10/03/2005
Last updated
10/14/2009
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