Basic Information
| Provider Information | |||||||||
| NPI: | 1811943152 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTHWAY HEALTH AND REHABILITATION, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1424 25TH ST N | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352342819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2053285870 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1424 25TH ST N | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352342819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2053285870 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2006 | ||||||||
| LastUpdateDate: | 09/14/2020 | ||||||||
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| AuthorizedOfficialLastName: | LONG | ||||||||
| AuthorizedOfficialFirstName: | PHILLIP | ||||||||
| AuthorizedOfficialMiddleName: | CODY | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 2053913600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 012651 | 01 | AL | BCBS ID | OTHER | 4757850S | 05 | AL | MEDICAID |