NPIMap

Organization Active NPI

Phoenix Healthcare LLC

  • Skilled Nursing Facility
  • Roanoke, AL
National Provider Identifier
1366493066
Registry record updated Dec 20, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
10641 Issued in AL
Legal business name
PHOENIX HEALTHCARE LLC
Practice address
1235 Yancey St
Roanoke, AL 36274-2141
Phone
(334) 863-3500
Fax
(334) 863-3531
NPI assigned
May 15, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2011

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

Authorized official

Name
Mr. Ronald Traylor
Title
Administrator
Phone
(334) 863-3500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 10641 AL Primary

Addresses

Primary practice location

1235 Yancey St
Roanoke, AL 36274-2141

Mailing address

PO Box 467
1235 Yancey Street
Roanoke, AL 36274-0467
Phone (334) 863-3500

Other identifiers 2

IdentifierTypeStateIssuer
4752240SMedicaidAL
021561OtherALBLUE CROSS BLUE SHIELD

Other names 1

  • Traylor Nursing Home, Inc Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1147651200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1324339200000",
    "number": "1366493066",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 467",
            "address_2": "1235 YANCEY STREET",
            "city": "ROANOKE",
            "state": "AL",
            "postal_code": "362740467",
            "telephone_number": "334-863-3500",
            "fax_number": "334-863-3531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1235 YANCEY ST",
            "city": "ROANOKE",
            "state": "AL",
            "postal_code": "362742141",
            "telephone_number": "334-863-3500",
            "fax_number": "334-863-3531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-15",
        "last_updated": "2011-12-20",
        "status": "A",
        "authorized_official_last_name": "TRAYLOR",
        "authorized_official_first_name": "RONALD",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "334-863-3500",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "AL",
            "license": "10641",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4752240S",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "021561",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Traylor Nursing Home, Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Roanoke, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2011; 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.