Organization Name:  ATHENS CONVALESCENT CENTER


Practice Location:
611 W MARKET ST  ATHENS, AL 35611 US
Tel: 256-232-1620  Fax: --

Business Mailing Address:
  ,   
Tel: --  Fax: --


Taxonomy:

Primary	Code	Category/Description	State	License Number
N	332BP3500X	Suppliers Durable Medical Equipment & Medical Supplies Parenteral & Enteral Nutrition	AL	N4201
Y	314000000X	Nursing & Custodial Care Facilities Skilled Nursing Facility	AL	54038

Other Provider Identifiers:

Issuer	Number	State	Type
MEDICARE PART A PROVIDER	015016	AL	01
	4757080S	AL	05

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin