Healthcare Provider Details

I. General information

NPI: 1003629809
Provider Name (Legal Business Name): DAC OF COPPERHILL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2025
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 INDUSTRIAL DR
COPPERHILL TN
37317-5632
US

IV. Provider business mailing address

1621 GALLERIA BLVD
BRENTWOOD TN
37027-2926
US

V. Phone/Fax

Practice location:
  • Phone: 423-496-3245
  • Fax:
Mailing address:
  • Phone: 615-550-9453
  • 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: MATTHEW J. WEISHAAR
Title or Position: CHIEF FINANCIAL OFFICER AND SECRETA
Credential:
Phone: 615-771-7575