MEDICARE: WAYNESBORO HEALTHCARE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	0000000278	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235543463
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WAYNESBORO HEALTHCARE, LLC

Provider Business Mailing Address
First Line	:	104 JV MANGUBAT DR
Second Line	:
City	:	WAYNESBORO
State	:	TN
Zip	:	38485-2439
Country	:	US
Telephone Number	:	931-722-3641
Fax Number	:	931-722-7215

Provider Business Practice Location Address
First Line	:	104 JV MANGUBAT DR
Second Line	:
City	:	WAYNESBORO
State	:	TN
Zip	:	38485-2439
Country	:	US
Telephone Number	:	931-722-3641
Fax Number	:

Authorized Official
Title or Position	:	TREASURER
Name	:	MR. KENNETH C HART JR.
Credential	:
Telephone Number	:	423-584-6755

Provider Enumeration Date	:	06/16/2014
Last Update Date	:	03/28/2019

Similar Medicare Providers

1538156575 — WAYNE COUNTY NURSING HOME
Practice Location Address:

104 JV MANGUBAT DR
WAYNESBORO, TN
38485-2439

Practice Phone: 931-722-3641
Practice Fax: 931-722-7215

1902827363 — STATE OF TENNESSEE
Practice Location Address:

102 J V MANGUBAT DR
WAYNESBORO, TN
38485-2439

Practice Phone: 931-722-3292
Practice Fax: 931-722-7249

1780713768 — SHERRY LYNN PRINCE
Practice Location Address:

102 JV MANGUBAT DR
WAYNESBORO, TN
38485-2439

Practice Phone: 931-722-3292
Practice Fax:

1649303314 — JANICE KAY ANDREWS R.N.
Practice Location Address:

102 JV MANGUBAT DR
WAYNESBORO, TN
38485-2439

Practice Phone: 931-722-3292
Practice Fax: 931-722-7249

1336314608 — STACEY LYNN THOMPSON
Practice Location Address:

102 JV MANGUBAT DR
WAYNESBORO, TN
38485-2439

Practice Phone: 931-722-3292
Practice Fax: 931-722-7249

1386995801 — GENA GARRARD RN
Practice Location Address:

102 JV MANGUBAT DR
WAYNESBORO, TN
38485-2439

Practice Phone: 931-722-3292
Practice Fax:

Directions to “WAYNESBORO HEALTHCARE, LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.