Active NPI
Heritage Health Care & Rehab, Inc.
- Skilled Nursing Facility
- Tuscaloosa, AL
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 12691
- Legal business name
- HERITAGE HEALTH CARE & REHAB, INC.
- Practice address
- 1101 Snows Mill Avenue
Tuscaloosa, AL 35406-2015 - Phone
- (205) 759-5179
- Fax
- (205) 759-5216
- NPI assigned
- Oct 4, 2006
- Last updated
- Aug 22, 2020
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. George L Jackson
- Title
- Administrator
- Phone
- (205) 759-5179
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 12691 | AL | Primary |
Addresses
Primary practice location
1101 Snows Mill Avenue
Tuscaloosa, AL 35406-2015
Mailing address
1101 Snows Mill Avenue
Tuscaloosa, AL 35406-2015
Phone (205) 759-5179
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4754110S | Medicaid | AL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031210000933 | AL | Part A Provider - Skilled Nursing Facility | 4880590736 | Practice locations: Tuscaloosa, AL |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1184719247. Details of each certification follow.
Skilled nursing facility certification: CCN 015371
- Legal name
- HERITAGE HEALTH CARE & REHAB, INC.
- Doing business as
- HERITAGE HEALTH CARE & REHAB, INC
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Aug 1, 1977
- Last certification
- Jan 27, 2022
- Beds
- 216
- Ownership / control type
- Corporation
- Most recent change of ownership
- Jan 1, 2004
- Organization structure
- Corporation
- Enrollment address
- 1101 Snows Mill Ave
Tuscaloosa, AL 35406-2015 - Nursing home name
- HERITAGE HEALTH CARE & REHAB INC
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Heritage Health Care & Rehab Inc
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Corporation
- Certified
- Aug 1, 1977
- Medicare certification status
- Active
- Certified beds
- 216
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 01D0301865 | Heritage Health Care & Rehab Inc | Certificate of waiver | Aug 31, 2026 |
National Provider Directory
National Provider DirectoryOwnership & related parties
All disclosed owners & managing parties 8
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Adp of the SNF | Jun 1, 2021 | ||
| Adp of the SNF | Nov 1, 2014 | ||
| Adp of the SNF | Oct 1, 2025 | ||
| Trustee of the SNF | Aug 1, 2012 | ||
| Adp of the SNF | Oct 1, 2025 | ||
| Blake E Jackson | Corporate Officer | Jan 1, 2019 | |
| Operational/Managerial Control | Jan 1, 2018 | ||
| Trustee of the SNF | Jan 1, 2018 | ||
| Adp of the SNF | Mar 23, 2018 | ||
| Trustee of the SNF | Jul 15, 2023 | ||
| Adp of the SNF | Oct 1, 2025 | ||
| Benjamin E Jackson | 5% Or Greater Direct Ownership Interest | Nov 25, 2003 | 100% |
| Corporate Officer | Nov 25, 2003 | 100% | |
| Corporate Director | Nov 25, 2003 | 100% | |
| Trustee of the SNF | Jan 1, 2003 | ||
| Adp of the SNF | Jun 10, 1975 | ||
| Trustee of the SNF | Jul 15, 2023 | ||
| Adp of the SNF | Oct 1, 2025 |
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Internal Medicine Physician
- Tuscaloosa, AL
- NPI 1801904636
Affiliated clinicians 1
Clinicians who list this facility as an affiliation in Medicare Care Compare.
-
- Internal Medicine Physician
- Tuscaloosa, AL
- NPI 1801904636
Nursing home
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159920000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1184719247",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1101 SNOWS MILL AVENUE",
"city": "TUSCALOOSA",
"state": "AL",
"postal_code": "354062015",
"telephone_number": "205-759-5179",
"fax_number": "205-759-5216"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1101 SNOWS MILL AVENUE",
"city": "TUSCALOOSA",
"state": "AL",
"postal_code": "354062015",
"telephone_number": "205-759-5179",
"fax_number": "205-759-5216"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "HERITAGE HEALTH CARE & REHAB, INC.",
"organizational_subpart": "NO",
"enumeration_date": "2006-10-04",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "JACKSON",
"authorized_official_first_name": "GEORGE",
"authorized_official_middle_name": "L",
"authorized_official_title_or_position": "ADMINISTRATOR",
"authorized_official_telephone_number": "205-759-5179",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "AL",
"license": "12691",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4754110S",
"state": "AL"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Tuscaloosa, AL
Sources for this page
- 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.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.