NPIMap

Organization Active NPI

Lafayette Extended Care

  • Skilled Nursing Facility
  • Lafayette, AL
National Provider Identifier
1205878097
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
12494 Issued in AL
Legal business name
LAFAYETTE EXTENDED CARE
Practice address
805 Hospital St
Lafayette, AL 36862-2817
Phone
(334) 864-8854
Fax
(334) 864-8851
NPI assigned
Jun 13, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mrs. Yvonne Butler
Title
Administrator
Phone
(334) 864-8854

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 12494 AL Primary

Addresses

Primary practice location

805 Hospital St
Lafayette, AL 36862-2817

Mailing address

PO Box 152
Lafayette, AL 36862-0152
Phone (334) 864-8854

Other identifiers 1

IdentifierTypeStateIssuer
4755600SMedicaidAL

National Provider Directory

National Provider Directory
Tax ID family
Lafayette Extended Care2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1150156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1205878097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 152",
            "city": "LAFAYETTE",
            "state": "AL",
            "postal_code": "368620152",
            "telephone_number": "334-864-8854",
            "fax_number": "334-864-8851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "805 HOSPITAL ST",
            "city": "LAFAYETTE",
            "state": "AL",
            "postal_code": "368622817",
            "telephone_number": "334-864-8854",
            "fax_number": "334-864-8851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAFAYETTE EXTENDED CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BUTLER",
        "authorized_official_first_name": "YVONNE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "334-864-8854",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "AL",
            "license": "12494",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4755600S",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lafayette, 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.