Organization
ANDALUSIA MANOR LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SAL-LEE SHA-REE SASSER (VICE-PRESIDENT)
(334) 222-4544
Entity
Organization
Contact information
Practice address
670 MOORE RD, ANDALUSIA, AL 36420
(334) 222-4544
(334) 222-4737
Mailing address
670 MOORE RD, ANDALUSIA, AL 36420
(334) 222-4544
(334) 222-4737
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4757890S
—
AL
Enumeration date
10/17/2006
Last updated
02/11/2010
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