Healthcare Provider Details

I. General information

NPI: 1912819335
Provider Name (Legal Business Name): TN SNF OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 KEYLON ST
MANCHESTER TN
37355-2413
US

IV. Provider business mailing address

811 KEYLON ST
MANCHESTER TN
37355-2413
US

V. Phone/Fax

Practice location:
  • Phone: 931-450-5150
  • Fax: 931-450-5070
Mailing address:
  • Phone: 931-450-5150
  • Fax: 931-450-5070

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: MATT NUSSBAUM
Title or Position: MANAGER
Credential:
Phone: 212-653-8730