MEDICARE: RURAL LIFE FOUNDATION, INC.

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	313M00000X	Nursing Facility/Intermediate Care Facility	0000000118	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	:	1740279777
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RURAL LIFE FOUNDATION, INC.

Provider Business Mailing Address
First Line	:	3575 LONESOME PINE RD
Second Line	:
City	:	SAVANNAH
State	:	TN
Zip	:	38372-5409
Country	:	US
Telephone Number	:	731-925-7221
Fax Number	:	731-926-3400

Provider Business Practice Location Address
First Line	:	3575 LONESOME PINE RD
Second Line	:
City	:	SAVANNAH
State	:	TN
Zip	:	38372-5409
Country	:	US
Telephone Number	:	731-925-7221
Fax Number	:	731-926-3400

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. RANDALL LEE DICKMAN
Credential	:	NHA
Telephone Number	:	731-925-7221

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	12/12/2016

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Directions to “RURAL LIFE FOUNDATION, INC. ” Practice Location

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