Healthcare Provider Details

I. General information

NPI: 1548303704
Provider Name (Legal Business Name): HIGHLANDS OF MEMPHIS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 05/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3549 NORRISWOOD AVE
MEMPHIS TN
38111
US

IV. Provider business mailing address

485 CENTRAL AVENUE NE
CLEVELAND TN
37311
US

V. Phone/Fax

Practice location:
  • Phone: 901-325-7820
  • Fax: 901-452-1573
Mailing address:
  • Phone: 423-478-5953
  • Fax: 423-472-6283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number0000000257
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0257
License Number StateTN

VIII. Authorized Official

Name: DENNY BARNETT
Title or Position: MEMBER
Credential:
Phone: 423-478-5953