Park Place Nursing and Rehabilitation Center, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

12523 Issued in AL

Legal business name

PARK PLACE NURSING AND REHABILITATION CENTER, LLC

Practice address

100 Park PL
Selma, AL 36701-7743

Phone

(334) 872-3471

Fax

(334) 872-8923

NPI assigned

Aug 29, 2006

Last updated

Feb 10, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Charles W. Hise

Title

Administrator

Phone

(334) 872-3471

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1156809600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1234224000000",
    "number": "1811005846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 PARK PL",
            "city": "SELMA",
            "state": "AL",
            "postal_code": "367017743",
            "telephone_number": "334-872-3471",
            "fax_number": "334-872-8923"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 PARK PL",
            "city": "SELMA",
            "state": "AL",
            "postal_code": "367017743",
            "telephone_number": "334-872-3471",
            "fax_number": "334-872-8923"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARK PLACE NURSING AND REHABILITATION CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-29",
        "last_updated": "2009-02-10",
        "status": "A",
        "authorized_official_last_name": "HISE",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "334-872-3471",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "AL",
            "license": "12523",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4750840S",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2009; 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.