Healthcare Provider Details

I. General information

NPI: 1063977072
Provider Name (Legal Business Name): TN MEM OP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2019
Last Update Date: 02/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3549 NORRISWOOD AVE
MEMPHIS TN
38111-5911
US

IV. Provider business mailing address

548 CEDARWOOD DR
CEDARHURST NY
11516-1010
US

V. Phone/Fax

Practice location:
  • Phone: 901-325-7820
  • Fax:
Mailing address:
  • Phone: 917-804-1661
  • 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: CHAIM LEIBOWITZ
Title or Position: MEMBER
Credential:
Phone: 919-804-1661