Healthcare Provider Details

I. General information

NPI: 1215451745
Provider Name (Legal Business Name): SKYLINE OF MIDSOUTH HEALTHCARE AND REHABILITATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2380 JAMES RD
MEMPHIS TN
38127-8806
US

IV. Provider business mailing address

2380 JAMES RD
MEMPHIS TN
38127-8806
US

V. Phone/Fax

Practice location:
  • Phone: 901-358-1707
  • Fax: 901-359-1798
Mailing address:
  • Phone: 901-358-1707
  • Fax: 901-359-1798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateTN

VIII. Authorized Official

Name: JOSEPH SCHWARTZ
Title or Position: MANAGER
Credential:
Phone: 201-635-1195