Healthcare Provider Details

I. General information

NPI: 1841332855
Provider Name (Legal Business Name): DYER NURSING HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 06/23/2020
Certification Date: 06/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1124 NORTH MAIN
DYER TN
38330-0160
US

IV. Provider business mailing address

PO BOX 160
DYER TN
38330-0160
US

V. Phone/Fax

Practice location:
  • Phone: 731-692-4545
  • Fax: 731-692-4447
Mailing address:
  • Phone: 731-692-4545
  • Fax: 731-692-4447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number351
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number351
License Number StateTN

VIII. Authorized Official

Name: MR. JERRY PARK
Title or Position: ADMINISTRATOR
Credential:
Phone: 731-692-4545