MEDICARE: COUNTY OF OBION

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	4445508
2	313M00000X	Nursing Facility/Intermediate Care Facility	0000000196	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

General Provider Information

NPI Number	:	1578697751
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTY OF OBION

Provider Business Mailing Address
First Line	:	1084 E COUNTY HOME RD
Second Line	:
City	:	UNION CITY
State	:	TN
Zip	:	38261-8006
Country	:	US
Telephone Number	:	731-885-9065
Fax Number	:	731-885-0669

Provider Business Practice Location Address
First Line	:	1084 E COUNTY HOME RD
Second Line	:
City	:	UNION CITY
State	:	TN
Zip	:	38261-8006
Country	:	US
Telephone Number	:	731-885-9065
Fax Number	:	731-885-0669

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. DONNA CHILDRESS
Credential	:	RN
Telephone Number	:	731-885-9065

Provider Enumeration Date	:	03/16/2007
Last Update Date	:	02/19/2025

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Directions to “COUNTY OF OBION ” Practice Location

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