Healthcare Provider Details

I. General information

NPI: 1871156083
Provider Name (Legal Business Name): ADAMSVILLE OPERATING GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2019
Last Update Date: 04/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 PARK AVE
ADAMSVILLE TN
38310-2461
US

IV. Provider business mailing address

544 PARK AVE STE B04
BROOKLYN NY
11205-1670
US

V. Phone/Fax

Practice location:
  • Phone: 731-632-3301
  • Fax:
Mailing address:
  • Phone: 929-900-2005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: ANSHEL NIEDERMAN
Title or Position: MANAGER
Credential:
Phone: 929-900-2005