Healthcare Provider Details

I. General information

NPI: 1922493592
Provider Name (Legal Business Name): OAKTREE HEALTH AND REHABILITATION CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2015
Last Update Date: 08/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 KIRBY GATE CV
MEMPHIS TN
38119-8203
US

IV. Provider business mailing address

2020 NORTHPARK DR SUITE 2D
JOHNSON CITY TN
37604-3100
US

V. Phone/Fax

Practice location:
  • Phone: 901-752-0772
  • Fax:
Mailing address:
  • Phone: 423-975-5455
  • Fax: 423-975-5405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JIMMY R LEWIS
Title or Position: CHIEF MANAGER
Credential:
Phone: 423-975-5455