Healthcare Provider Details

I. General information

NPI: 1609182716
Provider Name (Legal Business Name): HEALTH CENTER OF HERMITAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2010
Last Update Date: 08/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4347 LEBANON PIKE
HERMITAGE TN
37076-1243
US

IV. Provider business mailing address

4347 LEBANON PIKE
HERMITAGE TN
37076-1243
US

V. Phone/Fax

Practice location:
  • Phone: 615-871-8740
  • Fax:
Mailing address:
  • Phone:
  • 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: GREG BIDWELL
Title or Position: MANAGER
Credential:
Phone: 615-893-2602