Pleasant Grove Nursing and Rehabilitation Center LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

12574 Issued in AL

Legal business name

PLEASANT GROVE NURSING AND REHABILITATION CENTER LLC

Practice address

30 7TH St
Pleasant Grove, AL 35127-1962

Phone

(205) 744-8226

Fax

(205) 744-8211

NPI assigned

Sep 27, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Norbert A Bennett

Title

Co-Ceo

Phone

(716) 662-4955

Specialties & licenses 1

Addresses

Other identifiers 3

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1033200068",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 7TH ST",
            "city": "PLEASANT GROVE",
            "state": "AL",
            "postal_code": "351271962",
            "telephone_number": "205-744-8226",
            "fax_number": "205-744-8211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 7TH ST",
            "city": "PLEASANT GROVE",
            "state": "AL",
            "postal_code": "351271962",
            "telephone_number": "205-744-8226",
            "fax_number": "205-744-8211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PLEASANT GROVE NURSING AND REHABILITATION CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BENNETT",
        "authorized_official_first_name": "NORBERT",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CO-CEO",
        "authorized_official_telephone_number": "716-662-4955",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "AL",
            "license": "12574",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4757310S",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC BS OF ALAMBAMA",
            "identifier": "00385",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE COMPLETE",
            "identifier": "71-00024",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ray Merrill III, D.M.D.
• Mills Pharmacy at Pleasant Grove LLC
• Myluma Health and Wellness LLC
• Patrice Banks Patton, OTR/L
• Pleasant Grove Drugs Inc.
• Ebony Watkins Pollard, PHARM.D.
• Adina Rasheed
• Cassandra Denise Reedy
• J Shane Roberts, DMD
• Brian Andrew Rudolph

• Skilled Nursing Facility in Pleasant Grove, AL
• Providers in Pleasant Grove, AL by specialty
• Skilled Nursing Facility in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.